Forums Health Warfarin or Rivaroxaban? Reply To: Warfarin or Rivaroxaban?
#173
becky
9 Posts

Hi

My background: I’m a hospital pharmacist and I specialised in anticoagulation for six years until changing job in December. So I’ve had a lot of discussions like this with patients & doctors.

The advice below is general, and comes with the caveat that you haven’t provided any other information about your medical history (other than previous DVT), allergies, other medication, etc.

Lots of people get worried about knowing if they’re sufficiently anticoagulated on rivaroxaban. Actually, most drugs are fixed doses: Warfarin is the unusual one, because people respond so differently that we have to monitor INR. Rivaroxaban (and the other DOACs such as Apixaban) are more “normal” l in having a fixed dose, and only requiring a dose adjustment for kidney function or low body weight.

If you’re travelling, then the fixed dose of a DOAC would be advantageous to you. With warfarin, going to altitude, different diet, etc can all affect your INR, but you probably don’t have a way to check (unless you happen to have a Coaguchek machine and can self-test).

If it’s six years since your DVT, and you haven’t had any problems since, then I would probably suggest that you go on low dose Apixaban (2.5mg twice daily) rather than Rivaroxaban. There’s really good data for Apixaban at this dose, in terms of both risk of DVT recurrence and bleeding. The disadvantage is remembering to take it twice a day. If twice-daily dosing would be a real pain for you, then once-daily Rivaroxaban could still be the better option for you.

Happy to discuss further privately.

Becky