Alternative to Warfarin

[pellicle]

About 15 years ago my cardiologist proudly announced to me that warfarin would be superseded 'within 5 years'.

Not so far, Dr A.

and we'll be doing everything by TAVI and they'll last for 50 years...

the other one plays Jingle Bells

 

[acki46]

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

I’ve traveled to China (from Oz) three times over the past 9 months - in fact, I’m here right now, and I notice a significant drop in INR every time.

I put this down to a very different diet to what I would normally eat at home, including a lot more steamed leafy greens. I also tend to drink more (I.e most days) while I’m over here which should have the opposite effect.

Either way, I increase my testing to twice a week, adjust my dosage as required and get on with life. In future trips, I might even consider a prophylactic upping of my dose to preempt the drop.

It typically takes 1-2 weeks for me to stabilise when I get back home.

Dosing the diet has worked well for me so far and I intend to continue doing so.

Alex

 

[tom in MO]

so:

short answer: NO

and probably not in your lifetime.


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.

My cardio indicated that there are current trials for development of new anticoagulants for warfarin replacement. One of the reasons for looking for new anticoagulants is to find one that doesn't require routine testing with dose adjustment. This is an expense as well as a risk. He didn't go into details about trials and I didn't ask. He did say that Eliquis was found unsuitable for mechanical valve anticoagulants.

 

[pellicle]

Hi

I’m here right now, and I notice a significant drop in INR every time.

interesting, what sort of drop are we talking?

I put this down to a very different diet to what I would normally eat at home, including a lot more steamed leafy greens. I also tend to drink more (I.e most days) while I’m over here which should have the opposite effect.

indeed, although the time scales and the amounts may vary. Not knowing "by how much" and "in which direction" you see a change I can't say more.

However there are some interesting findings emerging on just where our vitamin K can come from (our own storage and our own gut microbiota). So perhaps because of the changes in gut microbiota that's enough to make a swing in the availability of INR ... so perhaps it could even be water?

Personally I know that when I travel to places with crappy water (even sticking with bottled water) it makes changes to my gut and that reflects in what comes out.

I would speculate that the cause of this was a change in my gut flora. Increasingly, we are uncovering and understanding the role that gut flora has on not only digestion but with producing stuff needed by us nutritionally. One such thing identified as being produced by the gut flora is vitamin K2. An excellent article on this linkage is found here at this link. The article discusses the role of vitamin K in clotting (the coagulation cascade mentioned above), the role of vitamin K1 and K2, and mentions the role that is thought to be played by bacterially produced K2 in gut flora. Some further exploration of the role of antibiotics is found at this URL.

Have fun in China ... while you can.

 

[Protimenow]

Even if an alternative to warfarin came out tomorrow, I wouldn't use it.

It'll probably cost $8 a dose, and may require daily dosing. And what are the benefits? You wouldn't have to be tested and managed?

I've been taking warfarin for 32 years. It's about ten to twenty cents a day. I self test, so if I don't waste a strip, my cost for testing is around $20 a month. Plus, its effects are pretty easily reversible.

I really don't see much advantage in replacing warfarin -- not worth the cost and the benefits (of not having to test as often?) don't make sense to me,

 

[Lisa from LJ]

I’ve traveled to China (from Oz) three times over the past 9 months - in fact, I’m here right now, and I notice a significant drop in INR every time.

I put this down to a very different diet to what I would normally eat at home, including a lot more steamed leafy greens. I also tend to drink more (I.e most days) while I’m over here which should have the opposite effect.

Either way, I increase my testing to twice a week, adjust my dosage as required and get on with life. In future trips, I might even consider a prophylactic upping of my dose to preempt the drop.

It typically takes 1-2 weeks for me to stabilise when I get back home.

Dosing the diet has worked well for me so far and I intend to continue doing so.

Alex

The rest of my statement that Pellicle didn't quote was ...unless you load up on kale, so yes, if you significantly increase your intake of leafy greens, it is more likely to affect your INR. I have days where I eat spinach, others where I eat broccoli, others where I each cauliflower and don't see it reflected in my INR.

It may affect how Warfarin is metabolized, but it may not so you can't measure it's effects with the INR. A lot of alcohol will definitely increase your chance of bleeding if you cut yourself because it's an anti-platelet.

As far as a prophylactic dose to preempt the drop, I've never heard of that and wouldn't think it's good science.

When I travel, my INR tends to go up. My diet is similar, my alcohol intake is similar, but I'm usually much more active, so that could explain it. It could also be the gut biome that Pellicle mentioned.

All in all, I've decided that overthinking INR doesn't work for me. I test every two weeks, do nothing if my INR is 2-4, and use the 10% rule if needed. If I'm going to be traveling for more than a couple of days, I test before I leave just so I know what I'm dealing with, but it rarely impacts what I eat, drink, or do.

 

[pellicle]

that Pellicle didn't quote was ...

Because there is a link created for anyone to go read the whole thing I didn't see the need...and just cited a specific point that was of interest.

 

[Lisa from LJ]

Because there is a link created for anyone to go read the whole thing I didn't see the need...and just cited a specific point that was of interest.

True, but I'm not sure he followed the link and the part about kale was important to his response.

 

[Elcarim]

and we'll be doing everything by TAVI and they'll last for 50 years...

Yeah, the very same man who told me that a bioprosthetic aortic valve would probably last me (a then 22yo) 20 years, by which point we'd probably have less invasive surgery methods...

 

[pellicle]

Yeah, the very same man who told me that a bioprosthetic aortic valve would probably last me (a then 22yo) 20 years, by which point we'd probably have less invasive surgery methods...

yeah ... hugs mate ...

 

[carolinemc]

so:

short answer: NO

and probably not in your lifetime.


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.

And some people can become allergic to warfarin. And there other meds that can be used when allergic reactions happen. Not unheard of.

 

[Lisa from LJ]

And some people can become allergic to warfarin. And there other meds that can be used when allergic reactions happen. Not unheard of.

Is it a reaction to the dye or the warfarin itself?

 

[Jeff Lebowski]

And some people can become allergic to warfarin. And there other meds that can be used when allergic reactions happen. Not unheard of.

 

[carolinemc]

Is it a reaction to the dye or the warfarin itself?

To the warfarin itself, there are a number who develop the allergy to it over time. There was one member here years ago who was on bridge for a surgical procedure and that was when the allergy was found when she went back on the warfarin. It happens. The doctors have the patient on another med for the Mechanical valve patient.

 

[carolinemc]

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

 

[carolinemc]

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

Causes the usual allergic affects and she was here many years ago. She was on bridge therapy for a surgical procedure and when she got back on the warfarin, she had a severe, serious reaction to the warfarin when she got back on it, in the hospital. There have been people on here that also have had allergic reactions on warfarin, over time.

 

[Chuck C]

Yeah, the very same man who told me that a bioprosthetic aortic valve would probably last me (a then 22yo) 20 years,

Telling a 22 year old that a tissue valve will last them 20 years is malpractice. I see that it lasted you about 5 years, which would be totally normal for a 22 year old. How do some of these clowns keep their medical license?

 

[pellicle]

How do some of these clowns keep their medical license?

group defence ... the AMA (note that first A is Australian) are tighter than a Rugby Scrum.