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Doctors & patients are saying about 'Beat Your A-Fib'...

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Walter Kerwin, MD, Cedars-Sinai Medical Center, Los Angeles, CA

Warfarin Users: NOACs now First-line Therapy

The use of warfarin (Coumadin, Jantoven) to prevent clots is no longer recommended for most A-Fib patients. With a superior safety profile, NOACs (Novel Oral Anticoagulants) are now recommended as first-line therapy for suitable A-Fib patients. NOACs include dabigatran (Pradaxa), rivaroxaban (Xarelto), Apixaban (Eliquis) and edoxaban (Savaysa).

Be advised: Do not quit taking prescription anticoagulants on your own. Talk to your doctor instead.

A-Fib treatment guidelines were updated in 2019 by the American Heart Association/American College of Cardiology/Heart Rhythm Society (AHA/ACC/HRS).

The guidelines recommend that Coumadin no longer be used to treat A-Fib except for a limited, specific group of patients. Instead, guidelines strongly recommend using NOACs (DOACs).

“New scientific studies show that NOACs may be safer for patients because there is less risk of bleeding, and they may also be more effective at preventing blood clots than warfarin,” said Craig T. January, MD, PhD, FACC, co-chair of the focused update.

NOAC or DOAC? You may be familiar with “NOAC” (Novel Oral Anticoagulants), but lately the acronym has evolved to “DOAC” (Direct Oral Anticoagulants), since they are no longer “new” or “novel”.

NOACs (or DOACs) Guidelines

The guidelines instead encourage the use of “novel [direct] oral anticoagulants” (NOACs or DOACs) which are better at preventing stroke and have fewer side effects. I’ve written about the NOACs several times:

…Eliquis (apixaban) tested the best and is the safest. But all NOACs are considered high risk drugs and should only be taken if there is a real risk of stroke. (Warfarin vs. Pradaxa and the Other New Anticoagulants)

For example, if you’ve been cured of A-Fib and are A-Fib free by a catheter ablation, you normally don’t have to take NOACs. You aren’t in danger of having an A-Fib stroke if you don’t have A-Fib. NOACs are not like taking vitamins. (Blood Thinners After Ablation

High Cost of NOACs: Co-Pay Card and Patient Assistance Discounts

I know NOACs are much more expensive than Coumadin. And I understand if you and your doctor may choose to continue using Coumadin because of the high cost of a NOACs.

But don’t give up so fast. There are resources to save on prescription cost. For example, here are two resources on Eliquis to check:

• has a very informative page about the NOAC, Eliquis. For example, see Eliquis Prices, Coupons and Patient Assistance Programs

• Eliquis Customer Connect: Bristol-Myers Squibb offers an Eliquis Co-pay card and program which might work to reduce your cost. See ELIQUIS Costs, Savings and Support.

“Eliquis Co-pay Card: Eligible patients may pay no more than $10 per 30-day supply for up to 24 months with an annual savings of $3800; for additional information, contact the program at 855-354-7847.”

Other NOAC drug companies may have similar discount plans. We offer these links to help you get started:

• Pradaxa (dabigatran), see PRADAXA Savings & Support
• Xarelto (rivaroxaban), see Get Savings and Support for XARELTO
• Savaysa (edoxaban), see The SAVAYSA Savings Card

If you are 65 or older, you may qualify for Senior Discounts.

Talk to Your Doctor if You’re on Warfarin

If you’ve on warfarin (Coumadin, Jantoven) to prevent blood clots, you know that this powerful drug can save your life. But warfarin treatment is a careful balance, and certain factors can tip the balance, increasing the risk of bleeding.

If you are taking warfarin, talk to your doctor about the NOACs and whether you should change from warfarin.

Taking an anticoagulants (and which one) is one of the most difficult decisions you and your doctor must make.

Medical ID: If you’re on any blood thinner, it’s a good idea to carry some kind of medical ID. If you have an accident involving bleeding, EMTs can call ahead to the ER and get the staff ready to help you. To print your own I.D. see: Print a free Medical Alert I.D. Wallet Card

Resources for this article
January, C.T., et al. 2019 AHA/ACC/HRS Focused Update of the 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation. Circulation. ACC News Story. Jan 28, 2019.

Updated AFib Guidelines Recommend NOACs to Prevent Stroke in AFib Patients. American College of Cardiology. Jan 28, 2019.

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