Alternative to Warfarin

[Jeff Lebowski]

Hello
Is a replacement for Warfarin for patients with mechanical heart disease being developed in the near future that will not have the adverse effects of Warfarin?
After all, we are in a period when technology is highly developed, but there is still no alternative drug to Warfarin on the market for 60 years?

 

[pellicle]

Is a replacement for Warfarin for patients with mechanical heart disease being developed in the near future

not that I'm aware of ...

that will not have the adverse effects of Warfarin?

what are the adverse effects you speak of?

To my observation the direct Xa replacement is actually a bit worse than warfarin.

 

[Jeff Lebowski]

what are the adverse effects you speak of?

what I want to talk about here is a drug that constantly interacts with different foods or medicines, causing changes in INR values.

 

[pellicle]

what I want to talk about here is a drug that constantly interacts with different foods or medicines, causing changes in INR values.

if I understand you here is the question, the new anticoagulants can't be easily measured as to their anticoagulant effect. So how do we know what effects foods and other drugs interaction has.

With warfarin we know.

I prefer to know

 

[pellicle]

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5310120/

We identified 109 eligible studies: 35 for dabigatran, 50 for rivaroxaban, 11 for apixaban, and 13 for edoxaban. The performance of standard anticoagulation tests varied across DOACs and reagents; most assays, showed insufficient correlation to provide a reliable assessment of DOAC effects.

 

[ATHENS1964]

There are no data to support the use of non-vitamin K oral anticoagulants (NOACs) in patients with MHVs. In fact, dabigatran, an oral direct thrombin inhibitor, was associated with a higher rate of valve thrombosis and bleeding complications in patients shortly after placement of an MHV compared with warfarin in the RE-ALIGN study [4]. No trial has been conducted to assess the safety and efficacy of anti-Xa direct oral anticoagulants. Therefore, anti-IIa and anti-Xa direct oral anticoagulants are strictly contraindicated (Class III) in patients with any MHV with and without atrial fibrillation [
https://www.escardio.org/Journals/E...heart-valves-part-2-antithrombotic-management

 

[tommyboy14]

There is a lot of work going into developing new anticoagulants as patents run out.

The latest in clinical trial are Factor 11 inhibitors. They basically still protect against stroke, but the occurence of bleeding is much lower.

Now, these are still in clinical trials for Afib and stroke patients. Once they come to market, I would expect the people at ON-X to have another go with another trial to show that their valve an be used with this new anticoagulant. This would be the third time (the first two trials with diagabatran and with Apixaban failed - people got more strokes and more bleeding than with warfarin). Perhaps they will be thinking third time lucky?

 

[carolinemc]

Hello
Is a replacement for Warfarin for patients with mechanical heart disease being developed in the near future that will not have the adverse effects of Warfarin?
After all, we are in a period when technology is highly developed, but there is still no alternative drug to Warfarin on the market for 60 years?

You need to speak to your cardio, there have been people that have reactions sometimes after doing bridge therapy. But for warfarin, we have to live with taking it and take blood tests once a year to check for effects. Not much of choices out there yet. But someday.

 

[3mm]

for warfarin, we have to live with taking it and take blood tests once a year to check for effects

Check for what effects? What specific blood tests? Thank you for this information!

 

[pellicle]

There is a lot of work going into developing new anticoagulants as patents run out.

But as valve patients are by no means the majority of target patients I can't be sure that such anticoagulants will be approved for us let alone " for patients with mechanical heart disease "

 

[tommyboy14]

But as valve patients are by no means the majority of target patients I can't be sure that such anticoagulants will be approved for us let alone " for patients with mechanical heart disease "

yes this is a very good point. I suspect that this is why all of the trials with warfarin alternatives have failed thus far. The drugs just arent designed for this purpose. Having said that I think doctors will try continue to try new anticoagulants on patients with mech valves just to see if they work. I will not be taking part in any such trial and given the track record of these trials wouldnt advise anyone else to do so either.

 

[pellicle]

I suspect that this is why all of the trials with warfarin alternatives have failed thus far.

actually I don't think even the purpose they are intended for they are very fit for purpose. However with 'stroke' patients the aetiology of the stroke is frequently unknown; so for all we know the drug is "effective" because they never had another stroke event for the drug to have worked on.

Unlike a mechanical valve whos causes of thrombosis are well studied and which operates on a second by second basis ...

People (not meaning you) watch too much fiction and begin to be unable to differentiate the bridge of the Starship Enterprise (and all of the magic in the sick bay) from Hospitals, Operating Theaters, ICU ... their phones, their EV's ...

The first regular episode of Star Trek, "The Man Trap", aired on Thursday, September 8, 1966, from 8:30 to 9:30 as part of an NBC "sneak preview" block.​

 

[pellicle]

so:

Is a replacement for Warfarin for patients with mechanical heart disease being developed in the near future

short answer: NO

and probably not in your lifetime.

that will not have the adverse effects of Warfarin

Warfarin has very few adverse effects, of which I believe that all of the NOAC's share ... but worse, without the benefits warfarin bring.

1. effectiveness at the desired purpose
2. ability to measure its effect
3. cost effectiveness

The only reason why people don't like warfarin is that it require you to think, to understand and to make measurements and informed decisions; AKA being able to make informed decisions. Seems an impossible ask doesn't it.

 

[JaneF]

After my MVR my doctor told me to manage my warfarin around my diet, rather than trying to manage my diet around my warfarin. I will freely admit I was intimidated at first, but have become accustomed to that mindset now. I rarely drink alcohol, but if I do have a drink on occasion I now have enough experience to know how to adjust my dosage slighted to accommodate the alcohol and have been successful in keeping my INR in range. With the exception of a period of time that turned out to be another underlying health condition.

The only thing I would tell anyone before a valve replacement is if you are considering having a midlife crisis and getting a tattoo, even permanent makeup ladies, do it before your MVR. Otherwise you have missed your opportunity. I know that will sound very superficial to some of you, but this old gray mare wanted permanent eyeliner and lip blush, because the older I get, the less I want to fuss with those things. A week between finding out I had to have surgery and actually having surgery wasn’t enough time for research on those kinds of things.

 

[pellicle]

DOACs have fewer interactions and require less monitoring

can you provide some links supporting this please? I thought they were basically the same.

Its not hard to manage warfarin ... unless you're a clinic.

 

[pellicle]

After my MVR my doctor told me to manage my warfarin around my diet, rather than trying to manage my diet around my warfarin.

applause for your Dr ... as one of the sayings goes here "dose the diet, do not diet the dose"

Best Wishes

 

[Lisa from LJ]

Almost 26 years on Warfarin. Call me old school, but even if there were options, I wouldn't change. I know Warfarin, I understand Warfarin, Warfarin & I are friends.

 

[Lisa from LJ]

applause for your Dr ... as one of the sayings goes here "dose the diet, do not diet the dose"

Best Wishes

But the truth is that diet really doesn't affect INR all that much...unless you go crazy with kale!

 

[Elcarim]

About 15 years ago my cardiologist proudly announced to me that warfarin would be superseded 'within 5 years'.

Not so far, Dr A.

Recently we had supply issues with Coumadin due to new packaging. I didn't have any trouble getting it but my GP said she had had to put a lot of her patients who were on it for reasons other than mech valves onto something else. I tend to forget that most patients are on it for other things. I've been on it 19 years, plenty have been on it for longer. Some of my older relatives used to say it ruined your teeth and made your hair fall out. I suspect those were more the effects of generations of poverty, poor health and poor nutrition. From my POV it is cheap, has no long-term side effects and does what it says on the tin.

 

[pellicle]

But the truth is that diet really doesn't affect INR all that much.

that's how it is for me, but I can't speak for others.