Which blood thinner is best for you?
Coumadin (Warfarin) has been used for the prevention of blood clots and stroke in patients with atrial fibrillation (a heart rhythm disorder) since 1954. With the advent of NOACS (new oral anticoagulants) 11 years ago, like Xarelto, Eliquis and Pradaxa, patients often want to have a say in the type of blood thinner they are prescribed.
While the TV ads will try to convince you that NOACS, now called DOACs (direct-acting oral anticoagulants) are best for you, it is not necessarily the right option for all patients.
“There are some who have been on Coumadin for a long time and they’ve been doing well. Their INR numbers are good (no highs and lows and they have managed well). We don’t really push them to change,” said John J. Guerin, MD, FACC, a cardiologist with Cape Cod Healthcare Cardiovascular-Falmouth.
“While we usually let the patient decide, there are times when we suggest that it would be better and safer to be on a DOAC,” he said. “If they are not having good control with Coumadin, if they are elderly, falling, have balance issues, or memory loss, taking a DOAC may be a better option.”
There are differences between the two types of anticoagulants that contribute to the decision of which one to take. Coumadin requires a blood test once a week or every other week to check how long it takes for your blood to clot, said Dr. Guerin. Another issue with Coumadin is interaction with certain foods, especially greens that have Vitamin K, which can antagonize or reverse the effect of the anticoagulant. Coumadin also interacts with other medications and may have some absorption issues.
“DOACs don’t have any real food or medication interactions,” he said. “You don’t have to monitor it because it’s absorbed more consistently, so you don’t have the ups and downs that you get with Coumadin and the interactions.”
The decision to take Coumadin or a DOAC sometimes comes down to cost, said Dr. Guerin.
“Patients are so surprised when they go to the pharmacy to pick up the first dose of a DOAC and it costs $500 or $1,000. The companies give us discount cards but it’s still expensive. The pharmaceutical companies haven’t moved towards generics and haven’t lowered their prices.”
Success Taking Coumadin
Jan Foster has been a patient of Dr. Guerin’s for 12 years and has been taking Coumadin for atrial fibrillation the entire time. She uses a Coagucheck XS to test her blood at home, which measures her response to the Coumadin she takes.
“Previously, I would go to the lab once a month to have my clotting level checked, but Dr. Guerin suggested the self-testing machine about six years ago,” said Foster. “I test once a week, call the results in to an 800 number with an automated list of questions that I answer or type into my phone. Debbie Connors from Dr. Guerin’s office will call me almost immediately to let me know if I need to make any changes to the dosage of the medication.”
From start to finish it takes her about five minutes to draw the blood from her finger, wait about 90 seconds for the results, and call them in.
“It’s a huge time saver for me because I don’t have to get into the car, drive to the lab, wait my turn to get my blood drawn and then drive home,” she said.
Foster likes the gratification of knowing the result of the test right away because it makes her more comfortable.
“I know I have the support of the staff at Dr. Guerin’s office, especially Debbie, who is very good at connecting with the patients. I’ve been doing this so long that she remembers who I am, and she can almost predict why my numbers are off.”
Foster admits to feeling a bit awkward testing her own blood at first but as time went by, she became more proficient.
“I would definitely recommend giving self-testing a try,” she said. “The Visiting Nurse Association of Cape Cod works with you to show you how to do it.”
