Coumadin Vs Noacs, And Inr Testing

I know someone with AFib and I am trying to compare the pros and cons of Coumadin vs NOAC. Also the doctor said Coumadin requires INR testing and NOAC does not. Is this really a benefit? Is INR testing really that cumbersome? As far as I know the INR testing needs to be done at Anticoagulation Clinics or use a home-monitor device. Has anyone found home-monitor better than clinics in terms of data transfer to the doctor? I am not sure if the clinics at CVS and Duane Reade offer the test.

I am trying to collect as much information as possible, so any guidance and feedback is appreciated.

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Most people prefer the other medications, due to the fact that INR testing must be done very regularly, requiring a finger stick, which may be painful… and most doctors will not let you have it done just anywhere, nor will they let you use the at-home monitoring, they want you to come in for them to do it. Silly, I know, but it's a hassle for many people.

The disadvantage of the new medications is that most have no way to be counteracted, if someone starts to hemorrhage.

Other typical side effects, as listed by the FDA may possibly including nausea, dizziness, headache, increased risk of bleeding and easy bruising.

My father took Coumadin for many years and did very well with it, but others may not like the inconvenience.

Can anyone else on these types of medications chime in?

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Re: Verwon (# 1)

Maybe someone can learn from my positive Coumadin experience. Life need not be chaotic. I am age 76 and have had full-time AFib for 30yrs. When I was under age 70yrs and had no cardiovascular risk factors or event history (TIA, DVT, etc.), I used 325mg/d aspirin as my anticoagulant. Published work indicates that in AFib folks under age 70 in good health, 325mg/d aspirin works as well as Coumadin or a NOAC for stroke/TIA prevention. I've never had any sort of event. At age 70, on cardiologist advice, I switched to Coumadin with twice-monthly home monitoring through Alere and my cardiologist's Coumadin clinic. When I test, it is always at 8AM. I wash my middle finger thoroughly and then heat it in 115oF water for ~2.5minutes before sticking. The lancets (Testwell Choice 21G X 1.8mm, Boca Medical Products) for finger-sticking are depth-calibrated to reliably obtain a painless, proper bleb of blood. The middle finger is big and fleshy. I alternate left and right sides, so one site is only stuck once/month. I ordered 5mg Coumadin tablets and quickly became a really good pill chopper (note use of 2.5mg and 1.25mg doses below).

During my first three-four weeks on Coumadin, I consumed a greens-free (basically minimal VitK diet), and calibrated my daily Coumadin dose with five or six home tests. My ideal Coumadin dose on a VitK-free diet proved to be only 2.5mg/d, that gave a very steady and reliable INR of 2.5-3.0. I habitually take my daily dose of Coumadin at bedtime, so I can look back at what I have eaten during the day. I love greens, but am very careful to remember what I have eaten. If I've eaten no greens, etc., then I take 2.5mg. For example, when I have eaten a big salad or a portion of greens/ cauliflower/peas (etc.), I take 5mg and then 3.75mg the next night, and my INR is reliably ~2.2-2.5 on a test the morning after taking 3.75mg. I never test the morning after a day when I have eaten salads or greens, because my INR does not recover that quickly. I have also run afoul of Excedrin and Nyquil/Dayquil and Preservision as meds that elevate INR. I'm sure there are others. I do my best to avoid all of them. If I do take one of those meds, I cut my evening Coumadin dose to 1.25mg. And... I always avoid testing within 36hrs after taking any of these.

With this strategy, I often go 3-4 consecutive months in range. I find that's about all one can hope for. As for responding to being out of range, one must accept that it will happen. When I am modestly low (INR 1.7-1.9), then I take 5mg that night, and return to customary dose next night. When I am modestly high (INR 3.1-3.3), I take 1.25mg that night, and return to customary dose next night. If I am lower than INR 1.7, I take 5mg for two nights, then return to customary dose next night. If I am higher than INR 3.3, I skip the evening dose and return to customary dose next night. Getting back in range within 36hrs is about all one can expect.

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