Are you on aortic or mitral valve ?Try to simplify things. A constant daily dose is the simplest approach. Unless the INR is way out of range small changes in the dose should be made.
Try not to markedly alter your diet. From say no salad to large kale filled salad every day. Get a home testing device and your life will be much better.
I usually take meds in the morning less likely to forget. Also don’t markedly alter other meds without monitoring the INR. Most people settle down and are pretty stable. I used to need 6 mg now I use 5 per day with an INR target near 2.5+. The data for low INR for Onyx valves was not compelling unless you are a fan of higher stroke rates.
Xarelto’s own website says it’s not for use for people with artificial heart valves. Are you taking it for some other reason?My cardiologist doesn't want me to be on Warfarin after surgery. He wants to use Xarelto instead so I have to only take one pill daily and still have a fairly normal lifestyle and not worry about what to eat or not eat. Many friends of mine (even my pharmacist) is on Xarelto and are very happy with the results of keeping 2.0-2.5 INR.
Here is a larger and more recent study of the use of Xarelto (rivaroxaban) compared with warfarin for patients with a bioprosthetic mitral valve and AFib. Note the caveat.My surgeon also said that he will more than likely not put me on warfarin. I did come across this article which was pretty interesting about the use of Xarelto in low risk patients who has a recent AVR with a mechanical valve...
Rivaroxaban for Valvular Heart Disease and Atrial Fibrillation - RIVERThe results of this trial indicate that rivaroxaban is noninferior to warfarin for prevention of thromboembolic events among patients with AF/AFL and a bioprosthetic mitral valve. All strokes were lower with rivaroxaban.
This is one of the first trials to directly evaluate the role of a direct OAC (DOAC) in patients with mitral valve disease and atrial arrhythmias. Historically, these patients have been treated with warfarin. Although this trial has limitations (open-label design, etc.), these findings are likely to be practice changing. The only caveat is that it is unclear if the mitral valve surgery was for rheumatic heart disease, in particular mitral stenosis, where warfarin is still recommended as the OAC of choice.
[/QUOTE]..........thus Warfarin could be extinct in the next decade?
If it works well, they’ll happily replace warfarin. Nobody makes any money off it at pennies a pill. It’s not patient safety that’s driving continued development. It’s the quest for drugs under patent that they can charge through the nose for.I think too that there are a lot of doctors and scientists that are performing studies and tests, with a vast greater knowledge than the consumers. It seems the consumer is always left in the dark until a breakthrough surfaces. This study of using Rivaroxaban for anticoagulant could be a game changer as it could possibly push Warfarin out the door. It is still a very new drug, but maybe they are finding that it works too well, thus Warfarin could be extinct in the next decade?
Exactly. Follow the money. The race for new anticoagulants is not driven by concern over patient well-being.I don't think it will take a decade. We have seen the patent holder of "Coumadin" discontinue production and a few of the major manufacturers of
"Warfarin" also leave the market. The ACT market is not driven by the relatively small mechanical valve users. The big market and big money is with the a-fib and similar chronic patient. My hope is that warfarin stays around for a few more years..........I'm reminded of the saying "the devil you know is often better than the one you don't know".
Therein lies the problem with US healthcare. Every one is shuffling deck chairs on the Titanic arguing about who pays for it. Until the cost gets under control, it won’t matter who pays for it. Whether it’s insurance premiums, deductibles, or taxes, it’s all just shifting costs around.Estimated XARELTO® Co-pay Cost | XARELTO® (rivaroxaban) (xarelto-us.com)
The list price of XARELTO® is $470 per month!
Just a touch more than warfarin?
Me too! BTW, the Xarelto TV ads also state "not for use with patients who have had artificial heart valve replacement" and they do not differentiate between mechanical or tissue". Screw-ups with warfarin can have irreversible bad results. I'd get approval, in writing, from the manufacturer, not a doctor, before using one of these newer ACT drugs after valve replacement..[QUOTE="Superman, post: 902436, member: 697
For the record, I take warfarin, lead a normal life, consistently test between 2.5 and 3.5, and don’t worry about what I eat or drink.
All clinical studies are listed in clinicaltrials.gov so nothing is kept in the dark. The study was to show 'noninferiority' which in FDA speak is equivalence. For heart valves, working means preventing clotting without causing internal bleeding but there has been very limited motivation to run the expensive clinical studies needed to show noninferiority for mechanical valve replacement patients since as was mentioned earlier, we're a relatively small market segment. I don't think i'd switch warfarin is working fine for me and I'm happy to pay very little for the generic.I think too that there are a lot of doctors and scientists that are performing studies and tests, with a vast greater knowledge than the consumers. It seems the consumer is always left in the dark until a breakthrough surfaces. This study of using Rivaroxaban for anticoagulant could be a game changer as it could possibly push Warfarin out the door. It is still a very new drug, but maybe they are finding that it works too well, thus Warfarin could be extinct in the next decade?