what are the risks/advantages of NOACS vs older anticoagulants

Hello,

I got to thinking about blood thinners & wondering about the details of what is really best or safest.

I remember Coumadin (rat poison) that my sister was on & how I took her all the time to get her PT/INR measured & it seemed it was never on target. If it was TIAs she was having causing her dementia, they apparently did not stop because her dementia progressed & it was eventually labeled early Alzheimer's before there was ever much talk about Alz. much less early Alz. Now my husband is on Plavix and bleeding from minor cuts & scrapes all the time. The doctor had told him he would be on it for 3 months postop a fem-pop bypass graft. He did get measured yesterday & his blood was too thin & will be getting an adjustment in his dosage. The doctor had told him that Eliquis was even worse about bleeding (I had suggested my husband ask him about taking that instead). Now the doctor says he will probably have to be on a blood thinner for life. My husband does a lot of physical work around here & is always getting cuts. My son-in-law who was a Medtronics person who assisted the drs in use of their equipment told me how they hated it when the blood thickness could not be measured prior to surgery (as with the NOACs). Then there are others who hate having to go through whatever it is they have to do to titrate off blood thinner prior to surgeries (even routine colonoscopies for some).

What are the options that seem best? I hear the Watchman is hard to get covered just yet, but I don't know the details. It seems everyone here is using a NOAC if they are on a blood thinner or a Watchman. I am not sure if I will have to be on one much longer if at all, but I am preparing for another year of uncertainty & getting insurance that will cover some of the drug cost at least.

Medically, does anyone care to share their preferences about this?

Thanks.

If the only concern was bleeding from external cuts, then a NOAC would be hugely superior to aspirin and Plavix. I've been on aspirin, Plavix, warfarin, Eliquis and Pradaxa, and I can say without hesitation that aspirin and Plavix will make small wounds bleed forever, especially if you're taking both. Eliquis and Pradaxa have little effect and don't prolong bleeding much.

But he's just had a femoral bypass and the studies on that have found that the NOACs cause twice as much bleeding as aspirin and Plavix. I'm sure you'd agree that the inconvenience of bleeding from small wounds is vastly superior to things like heart attacks and PEs. That's because aspirin and Plavix are anti-platelet drugs. They disable the ability of platelets to clump together and form clots, and with arterial surgery that's what you need. The NOACs work through a different mechanism and have no effect on platelets.

Before anyone asks why aspirin is rarely (if ever) prescribed for AF these days, it's because the situation there is reversed. For AF patients the chances of bleeds (particularly GI bleeds) is much lower with NOACs than with aspirin, and the NOACs are also superior at preventing clots from forming in the atria. The clots on a wound and the clots in AF form via different pathways, so different drugs are called for in his case vs. your case.

I love this group!!! Carey & Shannon are the best & everyone else who gives so much too.

I tried to find out information on the Internet about the comparison between Plavix & the NOACs and was coming up short in my search every time. My husband wrote an email to the nurse of the single practice Doctor who did his surgery and then he made an appointment to go in and talk to the doctor and he got very little information other than the doctor wanted him to stay on Plavix & they decided to check his clotting at last. They did need to lower the dose.

Thank you so much, Carey. I feel like I need to do something for you, like send you a box of chocolates. I haven’t done anything in return for all the help I’ve gotten from you. I just have to say I’m very grateful for the sharing of your knowledge and time. You will have good karma!! 🤗🙏🏻

Thanks. The karma will be enough.

All you ever wanted to know about the coagulation system but were afraid to ask.

[www.ncbi.nlm.nih.gov]

Quote
NotLyingAboutMyAfib
All you ever wanted to know about the coagulation system but were afraid to ask.

[www.ncbi.nlm.nih.gov]

Ok, so thank you for that. I read through it twice and understood every word of it. No, that would be lying as I only read through it once and didn’t understand a word of it. Well that’s not true either as I only quickly scrolled down through the article looking for pictures. But, no luck. Then I became angry knowing that there were such smart people in the world and why wasn’t I one of them. Then I became further depressed because, for the longest time, I thought “coagulation” had something to do with sex and it was just my luck to have been put on an anticoagulant. Yeah, so thank you for that.

p.s. I apologize ahead of time.



Edited 1 time(s). Last edit at 10/15/2020 03:54AM by walt.

LOL.... Don't even bother trying to read and understand that article unless you were planning on attending med school. I took a zoology course in college because it sounded interesting. Okay, it was interesting, but jeezus it kicked my butt. As part of that course we had to learn the entire coagulation cascade, which is insanely complex. Here's a diagram of how clotting works in your body:



See that part of the chart at the top-left labeled the "intrinsic pathway" that's circled? And remember how I mentioned that clots form differently in wounds and during AF? The intrinsic pathway is how clots form in your atria during AF. The area on the top-right labeled "extrinsic pathway" is how they form in injuries. Now that you have that utterly useless information, you can memorize it and regurgitate it on a final exam.

That diagram always astonishes me. It took decades and entire careers of hundreds of scientists to figure that spaghetti mess out.

Quote
Carey
LOL.... Don't even bother trying to read and understand that article unless you were planning on attending med school. I took a zoology course in college because it sounded interesting. Okay, it was interesting, but jeezus it kicked my butt. As part of that course we had to learn the entire coagulation cascade, which is insanely complex. Here's a diagram of how clotting works in your body:

[www.researchgate.net]

See that part of the chart at the top-left labeled the "intrinsic pathway" that's circled? And remember how I mentioned that clots form differently in wounds and during AF? The intrinsic pathway is how clots form in your atria during AF. The area on the top-right labeled "extrinsic pathway" is how they form in injuries. Now that you have that utterly useless information, you can memorize it and regurgitate it on a final exam.

That diagram always astonishes me. It took decades and entire careers of hundreds of scientists to figure that spaghetti mess out.

Hey, that’s the picture I was looking for !!!!!

Seriously though, insanely complex stuff for insanely intelligent people. Thanks for trying though!

OMG !
For my headache, do you thing I'd better go for paracetamol?

Sorry all - I was trying to help.

The thing is that for every clotting factor that says "clot" there is another that says "don't clot" so these work in harmony because without both sides we'd either bleed to death from a paper cut or clot up our arteries into sludge the very first time we suffered an insult to the endothelium. (Probably, Halloween night for most American children where a rush of sugar and insulin destroys the glycocalyx then attacks endothelial cells provoking the response to injury and resulting in the death* of the little goblins and princesses.)

*Takes decades of this abuse but typical more and more of the Standard American Diet.



Edited 1 time(s). Last edit at 10/15/2020 08:34PM by NotLyingAboutMyAfib.

“Halloween night for most American children where a rush of sugar and insulin destroys the glycocalyx then attacks endothelial cells provoking the response to injury and resulting in the death of the little goblins and princesses.”

I didn’t think of Halloween this year with covid19...I wonder if it’s going to affect the quantity of sugar goblins knocking on your door or if 7-14 days later there will be a spike of new cases?

Off subject...so to keep it an af related, I wonder how many people get af after this once a year sugar fest (adults munch on candy too) holiday compared to the rest of the year? Is there a spike of ecv at ER’s?

I've never heard of ERs seeing a higher influx of AF patients after Halloween and I doubt that happens. As an EMT I never noticed any uptick. After certain holidays, yes, but not Halloween. And those other holidays are due to alcohol, not sugar, hence the term Holiday Heart Syndrome.

As for sugar goblins coming to the door, that won't be happening at my house. A bowl of individually wrapped candy will be on a table outside the door.

“As for sugar goblins coming to the door, that won't be happening at my house. A bowl of individually wrapped candy will be on a table outside the door.”

A word of advice from past experience. The first group of kids will wipe you clean. I recommend to keep refilling the bowl so other kids will not see an empty bowl.

My pop was a dentist so he gave out toothbrushes. Kids hated him, parents loved him.

My father's brother was a proctologist, after he tried to mimic my father everyone hated him.

Susan's right - 1st unsupervised group will take all.

Nah, I live on a small street in a semi-rural/residential area. The kids who trick or treat here tend to be young and usually accompanied by parents, and the few older ones tend to be pretty decent kids. I expect they'll be okay. And we're known for giving out high-quality treats (typically Hershey chocolate almond bars), but I still think the kids will be respectful. I like where I live.

Carey please follow up afterwards.

I'll try to remember to do that.

It's kind of funny how this thread morphed from a serious question about anticoagulants to Halloween and sugar goblins.

Yet it was mentioned (disclaimer) by me that it’s af related to qualify for this forum and not the general by asking if there is a pattern of spikes in Af after eating all this sugar.