Anticoagulant

[carlyon bay]

I had an admission to the cardiac unit 3 months ago with atrial fibrillation discharged after 6 days with sotalol 80mgs twice daily clopidigrel 75 msg daily lisoapril 10mgs daily and 80 msg Atorvastin daily plus warfarin
I had a heart attack 12 months ago and had a stent implanted my question is ,would rivaroxaban be a more suitable anticoagulant to take as I'm always travelling and need to sign in as a temporary patient frequently as I need blood tests done often to check my warfarin levels which vary from test to to test at the moment it's 2.9 2weeksago it was 2.3 before that 3.8 before that 2.1 any comments would be helpful thanks

[Sqad]

Slaney is our expert on these matters, but for what it is worth:

If you are well controlled on Warfarin, then i can see no advantage in changing over to Rivaroxaban.

But as you seem poorly controlled, needing regular blood checks i think it may well be a good idea to change over, for convenience.

Wait for slaney's reply.

[pixie373]

I thought they always had regular blood tests with warfarin? Is that not the case with rivaroxaban?

[Aquagility]

Ask your cardiologist about Dabigatran, an anticoagulant which does not require frequent or regular assessment.

[carlyon bay]

No I've been told twice a year

[Sqad]

pixie.....again, not my area, but i think that the newer drugs,e.g Rivaroxaban, do not need monitoring.

[pixie373]

Ok. Thank you :-)

[slaney]

Interesting question - sometimes I wonder if I were to develop AF , which group of drugs I would chose.

Anticoagulation in AF may be with the newer drugs - apixaban, dabigatran etexilate, rivaroxaban (Factor Xa antagonists) or a vitamin K antagonist - warfarin.

The great advantage of the newer agents is that no routine monitoring is required, and they seem to work as well as warfarin in preventing strokes. Indeed some trials suggest they work a little better.
However it's important to remember that the risk of bleeding (for the newer drugs) is roughly the same as that of warfarin; however unlike warfarin there is no antidote should bleeding occur.

Looking at your results they are nearly all within the therapeutic range of INR 2.0 - 3.0. The 3.8 result was a bit out, but came back by the next test.
Poor control would be indicated by 2 INR greater than 5, or 2 INR less than 1.5 in any six month period.

The best thing to do would be to discuss with your GP whether you fit the criteria for rivaroxaban as it is not suitable for everyone....
http://www.nice.org.uk/guidance/TA256

[carlyon bay]

Thank you all for your support I certainly will discuss with my doctor and even pass a message onto the cardiologist who treated me following the AF that is a very valid point re antidote if anything happened thanks

[Brinjal]

I take rivaroxaban it's great convenient but costs an arm and a leg and a bit more. Don't know if it would be covered by your NHS but if so give it a try.

[carlyon bay]

Yes my doctor will prescribe it