Consider your condition and more when selecting an anticoagulation medication
By: Alere Staff
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Warfarin has been in use effectively treating blood clots since 1955.1 We know warfarin, we understand it and are comfortable with how to advise therapies around it. We are able to measure the effectiveness of the drug with a simple INR blood test that has been even further simplified with the ability to test at home. We also have a solid enough understanding of interactions, enabling us to often predict the effect on the INR for proactive warfarin dosing. |
Novel Oral Anticoagulants (NOACs), introduced in 2010, work differently in the clotting cascade than warfarin and offer the convenience of not requiring an INR test. For some, this is viewed as a major step forward in the world of anticoagulation. However, for patients that fall into the high-risk category, there is little information available to assist with NOAC therapy in these high risk populations.1 Patients that are considered high-risk are those with chronic kidney disease (CKD), those that are more than 75 years old and those who have had a previous stroke.
Uncovering the data regarding high risk conditions and type of anticoagulant
Due to the lack of long-term safety data and adequate data to support use in patients with severe kidney disease, NOACs have a general disadvantage over warfarin.3 To date, no published reviews have evaluated the effect and safety of NOACs for patients with chronic kidney disease (CKD) compared to warfarin, specifically those with creatinine clearance of less than 50ml/min.2 One study concluded that there is no significant advantage of warfarin over NOACs for these patients, however, the ability to monitor INR levels showed positive results in regards to stroke prevention and bleeding risk.2
Patients that are over 75 years old raise caution with healthcare professionals when considering anticoagulation. Stroke and bleeding events are important factors in this decision. The elderly often have multiple illnesses occurring together that could impact the effects of these medications. Unfortunately, the NOAC studies meant to determine patient safety included very few of this patient type, resulting in minimal guidance to offer healthcare professionals.4
Patients that have had a previous stroke raise even further caution when considering anticoagulation options. The first stroke is unfortunate enough but subsequent strokes can be detrimental. Due to the limitations of the NOAC studies, this high risk population was typically not included in the study population, providing results based on an extrapolation or small sample size. Again, minimal guidance is offered when prescribing anticoagulation.
Knowing how prevalent any of the scenarios are, it makes sense that healthcare professionals still use and recognize the safety of warfarin. A simple INR test seems of little consequence when it provides peace of mind with INR testing. The availability to test at home leading to increased time in therapeutic range makes warfarin therapy an appealing option for anticoagulation. It is well documented that increased time in therapeutic range leads to increased patient safety and less critical events.5
References:
- Hanley, Colleen M., Kowey, Peter R., (2015). Are the novel anticoagulants better than warfarin for patients with atrial fibrillation? Journal of Thoracic Disease, 5;7(2): 165-171. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4321074.
- Harel, Ziv. et al. (2014). Comparisons between Novel Oral Anticoagulants and Vitamin K Antagonists in Patients with CKD. Journal of the American Society of Nephrology, 25: 431-442. Retrieved from http://jasn.asnjournals.org/content/25/3/431.full.pdf+html.
- Faloon, William (2015). Important Data on 3 New Oral Anticoagulants. Life Extension Magazine. July issue. Retrieved from http://www.lifeextension.com/magazine/2015/7/important-data-on-3-new-oral-anticoagulants/page-01.
- Kato, Eri Toda, (2014). New Oral Anticoagulants in Elderly Patients With Atrial Fibrillation. American College of Cardiology. Retrieved from http://www.acc.org/latest-in-cardiology/articles/2014/12/10/11/28/new-oral-anticoagulants-in-elderly-patients-with-atrial-fibrillation.
- DeSantis, G., et al. (2014). STABLE Results: Warfarin Home Monitoring Achieves Excellent INR Control. The American Journal of Managed Care.
Warfarin & You
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General Information
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Health Conditions
- Anemia and Warfarin
- Cancer, Chemotherapy and Warfarin
- Going Back to Warfarin After Pregnancy
- Great News for Patients with Atrial Fibrillation
- Great News for Patients with DVT or PE
- Heart Failure, Atrial Fibrillation and Warfarin
- Inactivity and Your Risk of Stroke
- Mechanical Heart Valve
- Neutropenia and Warfarin
- Unexpected Results - Understanding Your Hematocrit
- Spotting a Blood Clot
- Stroke Awareness Month
- Stroke in Women and Dietary Flavonoids
- Strokes on the Rise But Risk Can Be Prevented
- Study Reveals Heart Attacks in Women Strike without Pain
- The Liver, Liver Disease and Warfarin
- Unexpected Results - Anemia and Your INR
- Unexpected Results – Lupus and APA
- What is Atrial Fibrillation?
- What is Factor V Leiden?
- Your Pulse and Your INR
- Stroke Signs and Symptoms
- Dialysis Increasing the Incidence of Atrial Fibrillation
- Managing Alzheimer's and Warfarin
- Pertussis (Whooping Cough) and Warfarin
- Heart Failure and Warfarin
- Raynaud's Disease and Home INR Testing
- Tools Used to Diagnose Heart Disease
- What is VAD?
- Cholesterol - Good vs. Bad
- Menopause, Warfarin and Your INR
- Migraine Treatment and Warfarin
- Tuberculosis and Warfarin
- Remote Monitoring Benefits of Patients with LVAD
- Home Monitoring Reduces Gastrointestinal Bleeding Events for LVAD
- What is DVT?
- Women and Stroke
- How often should I test my INR?
- The Cardiovascular System - Capillaries
- The Cardiovascular System - Your Heart
- The Cardiovascular System – Heart Valves
- The Cardiovascular System – The Arteries
- The Cardiovascular System – The Atria
- The Cardiovascular System – The Ventricles
- The Cardiovascular System – Veins
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Wellness
- Acupuncture and Warfarin
- Another Method to Catch Afib
- Bah Humbug! Avoiding Holiday Stress
- Bone Health - Importance of Vitamin K
- Chiropractic Care and Warfarin
- Diabetes and Warfarin: Balance with Diet
- Does warfarin make you chilly?
- Fido Becoming a Heart’s Best Friend
- Flu Shots & Your INR
- Fluids & Electrolytes
- Get Out and Play - Bowling
- Get Out and Play - Pickleball
- Going to the Dentist While Taking Warfarin
- Healthy Diet: Whole grains
- High Blood Pressure Control and Your Age
- Identifying Dangerous Blood Clots
- Importance of Controlling Blood Pressure While taking Warfarin
- Namaste: Yoga and Your Heart
- New Health Condition: What does that mean for INR & warfarin?
- Outdoor Summer Safety
- Planning Your Next Doctor’s Appointment
- Probiotics and Warfarin
- Prolonged hot weather can influence your INR
- Seasonal Allergies
- Seasonal Allergy Medications & Your INR
- Shingles and Your INR
- Smoking Health Risks and Warfarin
- Stroke & Dental Plaque – A manageable risk
- Tattoos & Warfarin
- The Cost of a Vaccine vs Getting Sick
- The Flu and Your INR
- Treating Heartburn While On Warfarin
- Understanding and Managing Stress
- What’s Your Risk of Stroke?
- Avoid those Winter Blues!
- Insomnia and Over-the-Counter Sleep Aids
- Exercise & Physical Activity
- Get Out and Play: Bocce Ball
- Managing Diabetes and Warfarin
- Volunteering is Good for Your Health
- Pneumonia, the Prevnar 13® Vaccine and Warfarin
- As You Age - Your Heart
- Heat Therapy
- Keeping Healthy Sleep Habits
- Patients Who Receive Lifestyle Text Messages Show Improved Health
- Chikungunya and Your INR
- Air Quality and Your Heart
- Men and Warfarin
- Sitting Exercises
- Heart Rate and Your Health
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Warfarin FAQ
- Warfarin Now Seems Natural
- Bridging Medication
- Purple Toe Syndrome
- Testing Methods for Your INR
- The Dangers of Being Labeled ‘Stable’
- The “Absolute Truth” about warfarin replacement drugs
- Travel Series: Altitude and Your INR
- Travel Series: Diet considerations in airports
- Travel Series: Helpful Hints for Air travel
- Travel Series: Traveling on Warfarin
- Travel Series: Your Diet
- Warfarin Side Effects
- Women & Warfarin
- Moving to Generic Warfarin Could Affect Your INR
- Warfarin or Dabigatran or Xarelto… the choice is a team decision
- Medications only work when they are taken as directed
- The Cardiovascular System - Your Blood
- The Cardiovascular System - White Blood Cells
- The Cardiovascular System - Platelets
- As You Age - Dexterity, Tremors and Balance
- As You Age - Eyes
- As You Age - Your Skin
- As You Age - Diet and Digestion
- As You Age - Hearing
- Comparing Warfarin to NOACs
- Consider your condition and more when selecting an anticoagulation medication
- Considering the cost of anticoagulation therapy
- Warfarin, NOACs and Reversal Agents
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Health Conditions
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Dietary (Food & Beverage)
- Vitamin K Levels in Foods – Impact of Cooking or Freezing
- Your Holiday Diet
- Your Metabolism
- Your Balanced, Healthy Diet
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Food Interactions
- Aged Garlic Extract and Warfarin
- Asparagus and Warfarin
- Avocado and Warfarin
- Bananas and Warfarin
- Blueberries and Warfarin
- Broccoli Sprouts
- Cabbage and Warfarin
- Celery and Warfarin
- Cereal Safety
- Coconut and Warfarin
- Cooking Oils and Vitamin K
- Cranberry & Warfarin OK Together
- Dandelion leaves & Warfarin
- Dark Chocolate and Warfarin
- Eating Prickly Pear Cactus (Nopal Cactus)
- Edible Seaweed and Vitamin K
- FDA Warns Against Mexican Vanilla
- Finding the TricK in Treats
- Food Substitutions Are a Simple Matter of Taste
- Garlic and Warfarin
- Gnocchi and Warfarin
- Grapefruit and Warfarin
- Greek Yogurt and Warfarin
- Licorice and Warfarin
- Mangoes and Warfarin
- Nut Butters and Warfarin
- Oatmeal and Warfarin
- Olestra (food additive) and Warfarin
- Olestra, a fat substitute - Can it affect your INR?
- Papaya & Warfarin
- Parsley and Warfarin
- Pho and Warfarin
- Pomegranate & Warfarin
- Salmon and Warfarin
- Smoothies and Warfarin
- Soy and Warfarin
- Special K® cereal and Warfarin
- Tofu and Warfarin
- Energy Bars and Warfarin
- Sorbet or Sherbet and Warfarin
- Sushi and Warfarin
- Muesli and Warfarin
- Microwave Dinners and Warfarin
- Spinach, Vitamin K and Warfarin
- Template
- Clam Chowder and Warfarin
- Dried Fruits and Warfarin
- Gumbo and Warfarin
- Cauliflower and Warfarin
- Kale and Warfarin
- MSG and Warfarin
- Quinoa and Warfarin
- Cilantro and Warfarin
- Radicchio and Warfarin
- Mushrooms and Warfarin
- Cardamom and Warfarin
- Basil and Warfarin
- Pistachio Nuts and Warfarin
- Potato Chips and Warfarin
- Hummus and Warfarin
- Kiwifruit and Warfarin
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Beverage Interactions
- Drinking Tea & Warfarin
- Alcohol and Warfarin
- Aloe Vera Juice and Warfarin
- Black Tea and Warfarin
- Chamomile & Warfarin
- Coconut Water
- Coffee and Warfarin
- Goji Juice and Warfarin
- Green Tea and Warfarin
- Milk Substitutes for Warfarin Patients
- MonaVie Products and Warfarin
- Wheatgrass and Warfarin
- Wine and Warfarin - Red vs White
- Weight Loss Shakes and Warfarin
- The V8® Beverage and Warfarin
- Meal Replacement Drinks and Warfarin
- Juicing and Warfarin
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Safety & First Aid
- Stop Bleeding Fast with New Topical First Aid Products
- Safety Tips for Winter
- Safety: Weather, Emergencies, & Natural Disasters
- Bone Fractures and Warfarin
- Warfarin and Bruising Risk
- Car Safety
- Common Injuries That Befall Seniors
- Detecting a Safer Home
- Dishwasher Safety
- Felons: A Matter on Hand
- Gardening Safety
- Home Safety: Cutting Edge
- Home Safety: Want to exercise, but worried about your diabetes and INR level?
- Joint Injury - The Shoulder
- Kitchen Safety and Safety Products
- Life Saving Medical ID Jewelry
- Nosebleeds
- Orthostatic Hypotension
- Proper lighting needed for medication identification
- Slipping on Wet Floors
- Staying Hydrated in Summer
- Sunburn and Heat Exhaustion
- The Pitfalls of Holiday Alcohol
- The Sting and Bite of Summertime
- Think Disasters Only Happen to Other People?
- Twigs and Falling
- Water and Pool Safety
- Wet leaves can present a hazard
- Safety & Fall Prevention: Learn How to Fall
- Compression Stockings for DVT (Deep Vein Thrombosis)
- Joint Injury - The Hip
- Look Out for Your Eyes
- Joint Injury - The Elbow
- Nosebleed First Aid and Prevention
- CPR First Aid
- First Aid for Thermal Skin Burns
- Preventing Infection - Proper Care for VAD Drivelines
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Drugs and Other Medications
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Natural Medicines & Vitamins
- Angelica herb & Warfarin
- Arnica, Natural Medicine
- Astragalus and Warfarin
- Bladderwrack Seaweed & Warfarin
- Blond Psyllium and Warfarin
- Bogbeans & Warfarin
- Bromelain and Warfarin
- Caffeine and Warfarin
- Capsicum and Warfarin
- Chlorella and Warfarin
- Chromium and Warfarin
- Cinnamon and Warfarin
- Cod Liver Oil & Warfarin
- Corn Silk & Warfarin
- DHEA and Warfarin
- Does Whey Protein Interact with Warfarin?
- Flaxseed Oil and Warfarin
- Ginger and Warfarin
- Iodine and Warfarin
- Iron and Warfarin
- Krill Oil & Warfarin
- MK-7: The Other Vitamin K
- Melatonin and Warfarin
- Multivitamins and Warfarin
- Omega-3 Fatty Acids and Warfarin
- Primrose Oil and Warfarin
- Safflower & Warfarin
- St. John's Wort and Warfarin
- Vitamin A
- Vitamin C
- Vitamin E
- Clotamin, a Multivitamin without Vitamin K
- Ginseng and Warfarin
- Glucosamine Sulfate and Warfarin
- Using Essential Oils and Warfarin
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Over-the-Counter Medications
- Airborne® supplements and Warfarin
- Alli® Weight Loss Medication & Warfarin
- Cold-EEZE® supplement and Warfarin
- Estroven® supplement and Warfarin
- Over-the-counter Creams and Ointments
- Senokot® Laxative & Warfarin
- Topical Arthritis Pain Medications
- Combination Therapy – Aspirin & Warfarin
- Emergen-C® Supplements and Warfarin
- Emergen-C® Supplements and Warfarin
- Prilosec OTC® and Warfarin
- How Ibuprofen Works
- The Nyquil™ Cold and Flu Medication and Warfarin
- Bismuth Subsalicylate and Warfarin
- The Vicks® VapoRub™ Product and Warfarin
- The Alka-Seltzer® Medication and Warfarin
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Prescription Medications
- Antibiotics and Warfarin
- Antidepressant Medications and Warfarin
- Azithromycin and Warfarin
- Belsomra® and Warfarin
- Casodex & Warfarin
- Cipro Prolonged Release Tablets and Warfarin
- Crestor® and Warfarin
- Dicloxacillin and Warfarin
- Dilantin and Warfarin
- Duavee® and Warfarin
- Duloxetine and Warfarin
- Evista, a controversial choice for warfarin patients
- Farxiga® and Warfarin
- Fluconazole and Warfarin
- GRASTEK® Allergen Extract and Warfarin
- Gefitinib and Warfarin
- Maxifloxacin and Warfarin
- Nalidixic and Warfarin
- New Diabetes Drugs and Warfarin
- Oral Corticosteroids & Warfarin
- Oral chemotherapy's black box for warfarin
- Quinine and Warfarin
- Rabeprazole and Warfarin
- Reclast® medication & Warfarin
- Requip® and Warfarin
- Testosterone and Warfarin
- Wellbutrin and Warfarin
- Yaz® medication & Warfarin
- Alprolix® and Warfarin
- Tamiflu® (Oseltamivir) and Warfarin
- Heparin and Warfarin
- Neurontin® and Warfarin
- A Protonix® Prescription and Warfarin
- Opioids and Warfarin
- Hormone Replacement Therapy and Warfarin
- The Viagra® Medication (Sidenafil) and Warfarin
- Multivitamins and Warfarin
- Your Medications, Best Practices
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Natural Medicines & Vitamins
- News Stories
- WellLife: A guide for living on warfarin
- Talking with Your Doctor