Warfarin

Hi Charles, like you I have not been put on Warfarin. I asked to be put on one of the new drugs, I was offered Apixaban and although that is taken twice a day, there is no messing about with regular blood tests. I think it all comes down to the fact that Warfarin has been around a long time and much cheaper!!! I was told that they prefer to put you on Warfarin because there is an antidote for it whereas with the new drugs there is not one! I think at the end of the day if we can have the choice, better to go for the one which I is less intrusive on our day to day lives!!

A matter of cost. Warfarin costs pennies plus about £10 for INR each check. Your drug:

 rivaroxaban 2.5 mg (light yellow), net price 56-tab pack = £58.80; 10 mg (light red), 10-tab pack = £21.00, 30-tab pack = £63.00, 100-tab pack = £210.00; 15 mg (red), 14-tab pack = £29.40, 28-tab pack = £58.80, 42-tab pack = £88.20, 100-tab pack = £210.00; 20 mg (brown-red), 28-tab pack = £58.80, 100-tab pack = £210.00

If you are seeing the cardiologist privately how much are you paying for your prescription? Not every one is suitable for the new drugs including any patient like me who has had a heart valve replaced,

I agree with you Avril, we should be given the choice of what drug to take. Just last week, I asked my GP to switch to an alternative  (rivaroxaban/apixaban) because there isn't any INR bloodtests as such  but they refused point blank. I explained that I was made redundant last year because I had to go for regular INR checks and new employers don't like the idea of workers taking time off. I think the term "blood clot" scares them.  

Uncontrolled bleeding scares them even more. A policemans wife posted here that he was going to have to give up his job due to the dangers of it. A school teacher posted that even he was now considered a liabiltiy in case of injury.

As employers have to employ a certain number of disabled people you could have asked to be classified as such. Many years ago a chap I worked with produced too much blood and had to go for blood letting once or twice a month. The company siezed on this and asked him if he minded being classed as disabled. 

Hi Derek, I never thought of it like that. Perhaps thats the way forward.

Some people may not want to be classified that way due to pride.

Were you made redundant because of the time off for blood tests? I can understand a new employer taking that into consideration but not an existing one. Under the circumstances surely your GP could have the session fitted in at a convenient time for you or give you a (costly) machine to let you take your own readings and phone the results to them .

The surgery I go to gives disabled and housebound patients a machine and they have an appointed time phone in their results. Our local hospital no longer do INR testing and it is all done at surgeries. In some other towns it is all done at pharmacies.

Yes I was made redundant because I had to take 4.5 months off due to the bloodclot then regular slots because of regular testing. They firstly said they wanted to retire me on ill health but occupational health said "no way" which they didn't like. Then they informed me I was to be made redundant. I have been offered jobs but as soon as they see "bloodclot" on the application form they retract their offer. I did ask about the inr machine but agan GP said no.

 

I wish that I had been your Union rep! You can buy your own machine although they are nearly £300. I expect that second hand ones come up on Ebay. Having your own machine supplied by the NHS would save the State from paying you unemployment/sickness benefit.  

Did you ever speak to your MP for advice on your redundancy that I would call unfair dismissal. Of course your redundany payment might have been very generous unlike the two I had:-)

 

I did have a really great bloke from the union at first but unfortunately for me both he and his wife died in a horrific car crash after the first meeting thus I had another lady who was absolutely crap. I totally agree with you Derek I'd much rather have a machine and continue teaching/working than take benefits (i'm living off of my redundancy at the moment).

unfortunately my MP is very much in the pocket of my former employer and wouldn't help. Others who have been treated badly at work approached him for advice and he just wrote a few standard letters and then refused to help further. As for my redundancy it wasn't fantastic but middle of the road.

A sad tale. Perhaps your MP will not survive May 7th.

Presciptions are on NHS so nowt to pay as I am 78

When I twice went to BUPA  consultants privately they did not give me an NHS prescriptoin for the drugs they prescribed even though I was over 65.

 

I took the private script to my doctors and they put it on my list of meds,no problem

Most GP's dislike prescribing expensive drugs.

They have no option but to prescribe if a specialist says you must have them

I and others have had problems with prescriptions after seeing consultants privately.

It also used to be a way to queue jump by seeing a consultant privately and then getting put on to his NHS list.

Probably different Health Authorities have differing viewpoints.

This is the situation in East Sussex:

Guidance on the prescribing of medication initiated or recommended either after a private episode of care or a referral to a tertiary NHS centre. 

Background. 

Trust prescribers are occasionally requested to prescribe on the NHS, medication recommended as part of a private treatment episode or a tertiary NHS referral. If this request is agreed to it may lead to additional costs for the local NHS if the medication is not one usually recommended by the Trust. There may also be occasions when the prescriber feels that due to clinical unfamiliarity they cannot satisfactorily monitor the treatment. Ideally patients should be made aware of the Trust’s position prior to starting a private treatment episode or a tertiary referral.  

With regards to private consultations recommending prescriptions to NHS GPs, the BMA’s Interface between NHS and private treatment (2004) states: 

“if the GP considers the medication recommended is clinically necessary, he or she would be required under the NHS terms of service to prescribe that medication within the NHS, even if the assessment from which the need was identified was undertaken in the private sector. The exception to this would be if the medication is specialised in nature and is not something general practitioners would generally prescribe”. 

“The obligation to prescribe does not arise if the medication recommended is not clinically necessary or if the medication is generally not provided within the NHS”. 

“Where the product is of a very specialist nature, requiring ongoing monitoring, some GPs may feel they have insufficient expertise to accept responsibility for the prescription and so refuse such requests”. 

“Other examples concern medications recommended by private consultants that are more expensive, but without good evidence that they are more effective, than those locally prescribed for the same condition within the NHS. In such circumstances, local prescribing advice from the Primary Care Trust may be followed by the NHS GP. This advice should be explained to the patient who will retain the option of purchasing the more expensive drug via the private consultant.

 

 

 

Hi derek76

​I have just joined the Anticoagulant Group, and find your posts interesting and very informative.

​I live in Wales, diagnsed with DVT two weeks ago - so now on Warfarin.

​My DVT specailist nurse tells me that INR test units may shortly be issued for home use - seems to be cost effective.

​My DVT clinic handout states.

​Alcohol - Take alcohol in moderation, not more than 2 units a day. 

How long do you expect to be on warfarin?

Home testing would over time be cost effective but would the NHS want the initial outlay?

Alcohol is OK if you don't binge and stick to the same level.

Quote:

  If you take warfarin you should avoid large amounts of alcohol, but moderate consumption (one to two drinks per day) are not likely to affect the response to warfarin if you have normal liver function. You may need a dose adjustment in addition to testing of your prothrombin time or International Normalized Ratio (INR). 

Cheers.

Hi derek76

​I've only been on Warfarin 10 days due DVT, presently on INR daily checks to stabilise dose. Hope to resolve, as I am due RTHR next month.

I hope it resolves for you by then. You would have been on warfarin or a NOAC then anyway.

My husband tried rivaroxaban. He had to stop after 2 weeks as had massive loss of energy. Could hardly get out of the chair to do anything...stopped...now OK 'ish'! Now trying apixaban