Many of you have had a deep vein thrombosis (DVT) or pulmonary embolus (PE) or know somebody who has been affected by these conditions. Some of you will have had a short course of treatment, but if you have had more than one clot, you will likely stay on long-term treatment. Currently, most people with a DVT or PE are treated with newer drugs such as dabigatran, rivaroxaban or … [Read more...]
I need surgery – on warfarin for atrial fibrillation
Atrial fibrillation is a common condition. It affects approximately 1% of the population and up to 10% of people over 70 years have AF. At some time, you may need surgery. If you take warfarin there is some additional risk. Most people are concerned that they have an increased risk of bleeding if they keep taking their treatment and an increased risk of a stroke if they stop. … [Read more...]
I need surgery – on warfarin for a heart valve
At some time, you may need surgery. If you take an anticoagulant for a replacement mechanical heart valve, there is some additional risk. Most people are concerned that they have an increased risk of bleeding if they keep taking their treatment and an increased risk of thrombosis if they stop. How do we decide what is the safest way to manage surgery? Assessing risk If … [Read more...]
Thanksgiving – The scientists who discovered anticoagulants
Even though we live in New Zealand, we like to celebrate the American tradition of Thanksgiving. We have a big family meal and give thanks for the birth parents of our three adopted children (Angela got this idea from Mia Farrow). Afterwards, we get out our Christmas tree and lights to start the long process of decorating inside and outside the house. I am interested in the … [Read more...]
Should I be worried, doctor?
When you’re on anticoagulants, you may have concerns that you’re not quite sure about. Should you bother your doctor? My patients often bring up these concerns towards the end of a visit and start by saying, “Should I be worried, doctor?” It is essential to mention anything that bothers you rather than silently worrying. Some concerns are more important than others. In this … [Read more...]
Warfarin History 3 – six years to find the cause
Like the plot of a movie... Warfarin has been used as a medication for more than 60 years. The discovery of Warfarin is interesting and sounds a bit like the plot of a movie; it includes a president, dead cattle, an attempted suicide and rat poison. Like many scientific discoveries of the last century it involved some serendipity, good fortune, the correct … [Read more...]
Quiz – Old or New – What’s best for you?
If you’re taking anti-coagulant pills, you have a choice between warfarin or one of the New Oral Anti-Coagulants (NOAC) such as Pradaxa/dabigatran, Xarelto/rivaroxaban or Eliquis/apixaban. We’ve chosen Pradaxa/dabigatran as the representative of the NOACs for this quiz. How much do you know about their differences? Completing this quiz may help you realise why either one is … [Read more...]
Stopping anticoagulants – 5 life-threatening excuses
Around 30% of people started on a long-term anticoagulant have stopped taking it by three months. This is not merely missing a few tablets or reaching the end of the time you needed anticoagulants for, but deliberately stopping while you’re meant to be taking them. And of course once people are no longer anticoagulated they’re at risk of a life-threatening stroke (if they have … [Read more...]