Warfarin to be superseded 'soon'?

[Elcarim]

I had my yearly review with my cardiologist a few weeks ago and he told me that there was a new drug in the pipeline and that he expected warfarin to be replaced by it within five years. He said that the new drug was a simple once-a-day oral medication and that INR testing would not be required with it.

Has anyone heard anything about this? I actually can't understand how it could work, surely clotting times will still need to be known? It would be great to be able to just take a tablet and know you were protected, no more adjusting doses and monitoring INRs, but I can't get my head around a mechanism that would allow this to happen.

 

[Ross]

Zero zip and nothing is on the table as a replacement for Coumadin in valve patients. Everything being tested has not met safety precautions.

 

[catwoman]

My surgeon told me the same in June 2003. Sorry, but that was just a Bah Humbug!

Any "replacement" for warfarin would probably work well enough for people like joint replacement patients, those with DVTs (maybe), etc. Most of those users are on warfarin for short-term.
But those of us with valve replacements are on warfarin indefinitely, and are at higher risk of strokes if not anticoagulated enough, and those of us with mitral valves are at the highest risk.

Most drug trials don't test long enough to determine whether a drug would be adequate for long-term or indefinite use. (That's only my opinion.)

A replacement for warfarin? No, thanks. Pass me my rat poison, please!

 

[musician2k]

My wife & I heard on the evening news tonight that Lilly here in Indianapolis was getting ready to seek final FDA approval for a new 'blood thinning' drug. This of course got our attention! Come to find out, though, that the drug will be called "prasugrel" and basically would be an alternative to Plavix. It's still a good thing, esp. if it turns out to be a more effective & safer drug but (unless I'm mistaken) it won't replace Warfarin, since it's an anti-platelet drug and not an anti-coagulant.

 

[S2R1000]

Bleeding vs Stroke

Bleeding vs Stroke

Id rather replace blood than brain cells. Thats right, cant replace the brain cells. Rat poison is fine with me. I try and look at cost benefits. Current cost vs current benefit, future cost vs current benefit, future benefit vs current cost, etc..... But then I am an egg headed engineer. Probably a bit OCD too

 

[catwoman]

Id rather replace blood than brain cells. Thats right, cant replace the brain cells. Rat poison is fine with me. I try and look at cost benefits. Current cost vs current benefit, future cost vs current benefit, future benefit vs current cost, etc..... But then I am an egg headed engineer. Probably a bit OCD too

And any "replacement" would be extremely expen$ive -- no generic available for X years.

What insurance company would be willing to pay $$$ for a new drug when it can get by with $ for Coumadin (trademark) or mere pennies for warfarin?

Most would probably say the drug's not in their formulary!

 

[netmiff]

my ACT doc (I saw him yesterday) is Dr. Sam Schulman, from Sweden, now working at Hamilton Health in Canada. Apparently a leading researcher in the field etc., he was headhunted to come to Hamilton, which is a world-leading ACT research facility (according to them). Anyway, he said there is a new drug that should get approval in Europe in the next few months, for short-term, but that there are other options in the works. Said maybe 5 years for long-term use. Sorry, I don't think he mentioned the name of the drug.

 

[Ross]

my ACT doc (I saw him yesterday) is Dr. Sam Schulman, from Sweden, now working at Hamilton Health in Canada. Apparently a leading researcher in the field etc., he was headhunted to come to Hamilton, which is a world-leading ACT research facility (according to them). Anyway, he said there is a new drug that should get approval in Europe in the next few months, for short-term, but that there are other options in the works. Said maybe 5 years for long-term use. Sorry, I don't think he mentioned the name of the drug.

The problem is, the drugs are being tested on hip replacement and ortho patients and not mechanical valvers.

 

[catwoman]

The problem is, the drugs are being tested on hip replacement and ortho patients and not mechanical valvers.

Ross:
My sister had a hip joint replacement in 1998, I think, and only took aspirin afterward. My mom had a knee joint job in May 2007 and was first told she'd be put on warfarin, but got aspirin instead. I've talked to quite a few who've had joint replacement, and it appears there may be a trend toward aspirin instead of warfarin post-op.
I'm sure my sister will need a hip joint redo in 5-10 years. Will be interesting what she'lll get then.

 

[tobagotwo]

Brief response, not to hijack the thread...

In response to the mention of potential short-term anticoagulants that may be in testing or approval-seeking phases for some orthopedic surgical uses, one compound you might Google is rivaroxaban (aka Xarelto). Note that rivaroxaban is the active ingredient in Xarelto, like enoxaparin is in Lovenox, and warfarin is in Coumadin.

Best wishes,

 

[netmiff]

I should also have mentioned that he said it was one-dose-fits-all med, and NO TESTING required

 

[catwoman]

How different is this from Exanta (AstraZeneca)? That was touted to be a one-dose-fits-all and no INR testing needed. However, I believe periodic tests were needed for liver function.
That drug was shelved, if I remember correctly, after some problems surfaced.

 

[Ross]

This is where we need Al Lodwick to be coming around again.

 

[MikeHeim]

I, for one, applaud companies trying to advance health care and medicine going forward. It'll be a sad day when manufacturers decide that we've gone "far enough" and there's nothing left to work on. Just as new and future generation valves (tissue and mechanical) will continue to improve on the deficiencies of the current designs, there's no reason to believe that there won't be future generations of anti-coagulants that can further reduce the already low risks of Warfarin. The fact that there have been past failures in this area doesn't mean there shouldn't be optimism for the future.

 

[Elcarim]

Very interesting, thanks guys.
I am in no hurry to switch, warfarin has a long track record and people have been on it for many years with no major side effects. Being that I am only 30 and will be on it for many years I like knowing that it will not make me grow another head or make my liver shut down!
My cardiologist is of the opinion that there will be many changes to the way defective valves are treated in my lifetime. I really do wonder what the future holds. I wonder if thirty or forty years from now I will have a valve made from my own cultured tissue and my pacing node will be repaired with stem cells so I won't need a pacemaker any more. And I wonder if I would put myself up for another surgery if there was a chance I could come out of it without any metal bits. I try not to think about it too much and I am thankful that I have the opportunity to live a healthy, active life despite the complications I have had.

 

[catwoman]

I, for one, applaud companies trying to advance health care and medicine going forward. It'll be a sad day when manufacturers decide that we've gone "far enough" and there's nothing left to work on. Just as new and future generation valves (tissue and mechanical) will continue to improve on the deficiencies of the current designs, there's no reason to believe that there won't be future generations of anti-coagulants that can further reduce the already low risks of Warfarin. The fact that there have been past failures in this area doesn't mean there shouldn't be optimism for the future.

Mike:
I agree. I'd like to see a new anticoagulant.
But we must remember that probably (my guess) is that the vast majority of people taking anticoagulants are doing so for a limited time period -- first-time DVT/PE, for a joint replacement, etc. Thus, they won't be on it long enough to experience serious side effects, as opposed to those of us who must be on it indefinitely because of a mechanical heart valve. Something might not show up after just a few weeks or months of use, but might show up after extended months or years of use.

Because of that, I will be more comfortable continuing with warfarin until several years of satisfactory results are available for trials with mechanical valvers. After all, you can replace blood cells, but not brain cells.

BTW, my sister has lupus and rhematoid arthritis. She used Vioxx for pain -- had to go off periodically because it raised her BP -- and then it was pulled from the market because of side effects. Those side effects were apparently not evident at first, only after extensive use.

But -- yes, let's see a safe alternative for warfarin.