WannaB wrote:
ChrisM wrote:
Thanks for the comprehensive post. When I went on AC in 2009 all they really had was warfarin. I’m managed fine, test at home, am fairly stable in the low 2s and don’t really pay attention to diet. Didn’t want to switch to rue DOACs when they came out as there was no reversal agent , and I continue to do tris, skiing, MTB etc.
But 14 years of reporting my INR to a clinic only for them to bill me $45 (with insurance) and say “carry on” is getting super old
I was google medicine-ing this morning and found the xarelto approved reveal agent and got excited about finally switching. But sounds like maybe it’s still not a thing yet. Thoughts?
So there is now an FDA approved reversal agent specific to both Xarelto and Eliquis. Andexanet Alfa. It is given as a continuous infusion. As I mentioned above in my little Wikipedia page, there is a real risk of downstream thrombosis associated with it, so it is reserved for life threatening bleeds. The biggest role at present is for intracranial hemorrhage with an indication for emergent neurosurgical intervention. Also a role in emergent cardiac surgery. The other scenarios aren't well defined, and may evolve over time. It is anywhere in the range of 20-45K a dose, last I was updated. So base on all of this, it is not universally stocked and available at all hospitals and systems. More the large centers that can absorb cost burden of stocking and have the surgical subspecialties for emergent surgery.
I don't have a lot of heartburn with people on Eliquis or Xarelto. We manage many people well with acute hemorrhage on these agents, can try to use 4-Factor Prothrombin Concentrate (PCC) to reverse, which may have some effectiveness (there is debate regarding how much). But if you want the absolute easiest to reverse agent while being highly active, then Warfarin makes sense if you are dialed in over years.
ETA: Head to head studies actually show long-term Eliquis and Xarelto more effective with less bleeding risk than Warfarin, mostly due to steady state of dosing. I really use these as go to.
s.
What are your thoughts on how quickly xarelto and eliquis stop being effective. My understanding is that it is fast compared to warfarin. But cannot reverse in hours as is the case with warfarin. I like xarelto and eliquis for patients going in for planned surgery because we don't have to do a lot of bridging like we did with warfarin which was a pita. Do you have idarucizumb in America. Apparently it reverses dabigatran in minutes. And only costs 4000 dollars.
They constantly try to escape from the darkness outside and within
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