rivaroxaban

I have always been told that warfarin is the cheaper option and that surgeries get around £10 per INR test and most patients don't need them every week. In some areas pharmacies are now doing the tests instead of GP's. The surgery I go has around 300 patients on Warfarin.

i was horrified to find out that gps's get money from the government from the Quality and Outcomes scheme - each diagnosis and prescription of drugs gets them points. 1 point is equivalent to around £60 and putting someone on wafarin or similar gets them around 10 points per patient - do the maths.  its quite difficult to find out this information on the internet  - but this aplies to lots of other conditions - don't know why this hasn't been on some sort of panarama programme  and begs the question if they are paying GP's to prescribe who are paying the government?

I must search for this. Is this not just for certain conditions? They get around £250 a year for a diabetic patient and are now being paid to test for dementia.

I have commented to doctors that they in the main ignore hypertension and concentrate on diabetes because of how they are funded

They also get increased funding for the elderly. 

Does he then adjust his dosage?

Yes. If his INR goes over 2.1 he has dreadful side effects, so I sort the amount he takes very carefully.

He has been using the machine for about 2 years and sorting his own tablets.

Our GP didn't want him to do it...we then found out that they were paid to do the test!!

How do you work out how to adjust the dosage?

Not a lot, about £10-£12 a test. Most want to be rid of the job. The GP I go to has over 300 patients on Warfarin and INR testing is over two nurse says a week. Pharmacies are taking the job over in many areas. 

300 x £10 = £3,000....Mmmmm!

Dosage depends on how high or low the INR has got. If its .5 or less then we cut down by 1.5mm for a couple of days and re check. same the other way but up the dosage then re check...after a a few goes its fairly easy to work out what to take. If the INR is very high don't take any for a day or two then start again. This has kept his INR at 2 to 2.1 for 2 years now...if it goes above 2.1 then his eyes bleed, he gets blood blisters all over his back and his hair falls out...plus he gets really nasty.

I worry about the eye bleeds as if that is showing, what is happening inside!

Not all come every week for testing and housebound/disabled have a home monitor and phone in results at an appointed time. Two nurses spend all day Wednesday on it and part of Monday so it restricts their other activities and they would not have space for another nurse at the moment.

They have plans to move into a building just over the street from us. That will be handy:-)

I have heard of eye bleeds before but a doctor denied to someone that it happens.

I had painful weight bearing joints when I was taking it and when I told my GP that I was stopping it he said that I was the third patient this week. I had to take it again when waiting for a second cardioversion and the joint problem came back. A neighbour has the same problem when walking and her hair has fallen out. Like me her joints are OK when no weight on them and she can cycle.  

A neighbour who has been on Warfarin for years puts up with a lot of side effects because of his family history.  Recently when in Spain he had a massive stomach bleed and neded two days in hospital and blood transfusions. He was worried when he was off Warfarin for a few weeks but now he is worried by being back on it.

Around 1980 I worked with a woman who was on Warfarin after heart surgery. Her consultant told her the good news is that I have never had a warfarin patient who has developed cancer. I have not found any reports on that but Aspirin thinning the blood is said to reduce/prevent colon cancer.

I think she used that as an excuse to continue smoking.

Derek , your neighbour on Warfarin was lucky he was not prescribed a non-monitored anti-coagulant like dagibtran , rivaroxaban and apixaban as these , unlike Warfarin have no quick - acting antidote . Currently I understand that the only action when on these three newer drugs is to wait until the daily dose has passed through your system .

He was lucky but in emergency he let them take him to the nearest clinic and it cost 1500 Euro's a day and 1000 Euros for the blood.

Derek , two interesting points here for all readers ....  I am unsure whether your neighbour was registered for a  EHIC ( European Health Insurance Card ) and what exchange options were open to him . The second was what level of travel insurance he had at the time and what exclusions there were . This is to me important , some years ago my wife became ill overseas and had travel insurance as an extra on her card with a major UK bank . She was brought back with expert escorting practitioners under the terms of her policy .

He had his EHIC with him but he just wanted to get to the nearest hospital ASAP. The bleeding was caused by unknown stomach polyps.

I did not ask why he was not insured. I expect that like me age and existing conditions rule him out.

The hospital wanted to keep him longer but at 1500 Euros a day he felt that two days was enough.

Thanks for all that , I really feel for your neighbour , it must have been traumatic for him .

When away he always had an address of a local INR clinic to have his checks done but that does not stop a bleed from happening.

Oh God! What rubbish...my husband had mostof his colon removed with bowel cancer.....What on Earth was the consultant on...