There are three new drugs that are used now. Dabigatran, rivaroxaban and apixaban and these are called the new anticoagulants and they have certain advantages over warfarin, most obviously that they don’t require you to have regular blood tests to monitor how thin your blood is because, by and large, the dose that you’re prescribed, provided it’s the right one for your age range, is likely to be the correct dose for all people in that group. So you don’t have to adjust the dose but the other advantage is that the limitations on diet, which, you know, the advice over restricting certain foods in the diet, which applies to warfarin, doesn’t apply to these other drugs. And so the person is more likely to be able to relax about that. However, they are new drugs. We still haven’t enough experience of using them to know for sure how safe they are in the long run. They’re not without side effects and they’re not without interactions with other drugs, so they need to be used carefully in selected people for whom there are problems with warfarin or people who are unable or unprepared to take warfarin.

Well, if they were available I would certainly consider them, because if they are better than aspirin but there’s one, I can’t remember the name, it doesn’t matter, but it does you don’t need to monitor it. You just take and I think you take one tablet a day and it’s it is as effective as warfarin, without any of the side effects. I don’t know anything about how it works physiologically, but I know it’s extremely expensive. So if it was available, yes, I think most people would take that up because they wouldn’t have to go to hospital every fortnight and have a blood test and then be told, Oh, alter your dose.

I can’t remember the name of the drug but I mean I think theres been a fairly recent breakthrough. Which I have, I mean I discussed with the consultant, not sure whether it was last time or the time before that the consultant, I discussed it with him. At that stage, we thought since the warfarin since I have no problem with warfarin, since it’s relatively stable, that it might be better just to stay with warfarin. And I haven’t really thought about it since then, you know. I haven’t really worried about it since then but it’s something I’d keep under review.

The latest developments on replacements for warfarin are very interesting but, of course, we’ve still got to say, fine, they’ve had clinical exposure. They’ve had trials. You can’t put anything on the market until the trials are completed. I know in the past, there have been some pharmaceutical companies who have suppressed some of the trial data. That has been very dangerous and very wrong, and the ethics around them should be improved and I think the oversight should be improved. I know there’s a lot of criticism of NICE that they haven’t allowed certain drugs to be put into clinical practice, whereas I think they are a bulwark against bad ethics. And they’re also there to make sure that you get a good bang for your buck because there’s only a limited pot of money.

I’ve already I’ve already made the consultant cardiologist aware, at the last meeting, when he said to me about going back on warfarin, that I, he I said to him, I understand theres another tablet that they’ve been testing throughout Europe. And he said, What do you feel about it? And I said, I’m very supportive. Absolutely supportive of the tablet and, hopefully, it can be introduced in the UK. Yeah, so I’m very much pro, I, you know, I’ve read what AFA have said about it and I personally don’t, can’t see anything against it. It seems to me, at the moment, NICE are very sceptical because of their cost analysis they’ve done, and I can’t necessarily, as a patient, agree with that because I think they’re primarily putting cost against patient care and patient risk.

I have, because I’ve been in AF, I’ve had AF for such a long time, since I was thirty, for a very long time, there’s been a pressure on me to go onto warfarin, which I did not want to do, mainly for quality of life, the fact that you have to, you know, are constantly having blood tests to make sure that all is well. And so I kept on saying, All right, I’ll do it when I’m sixty. Or, I’ll do it when I’m sixty five, I’ll. And I went on and on like this, putting off the decision being persuaded by not just the consultants at the cardiology unit but also by my daughters, who are doctors, that my risk of stroke, etcetera, etcetera, that I ought to be on a more effective blood thinner than aspirin. And I, finally, because, eventually, they have produced a blood thinner, which is not warfarin, that’s dabigatran, I finally agreed last, I think it was some time last autumn that I would go onto dabigatran.

And the advantage of taking a blood thinner, as opposed to not taking one at all, I suppose are that the older you get, the more likely, in AF, of your risk of stroke and that is that is quite a, you know, that is quite a serious risk anyway because, obviously, your risk goes up as you get older. So yeah, I mean I can see that it was sensible to go onto it.

I gather is that they’re working on an antidote but that would be I think that would probably make acceptable to a lot of people to feel that, should there be a situation where, for instance, they need immediate surgery, which is another problem. I had to have an endoscopy a couple of weeks ago for a totally unrelated problem and, because I had to stop the dabigatran for seventy two hours before I could undergo the surgery. And had had that been an emergency operation, it would have been a problem right.

The latest developments on replacements for warfarin are very interesting but, of course, we’ve still got to say, fine, they’ve had clinical exposure. They’ve had trials. You can’t put anything on the market until the trials are completed. I know in the past, there have been some pharmaceutical companies who have suppressed some of the trial data. That has been very dangerous and very wrong, and the ethics around them should be improved and I think the oversight should be improved. I know there’s a lot of criticism of NICE that they haven’t allowed certain drugs to be put into clinical practice, whereas I think they are a bulwark against bad ethics. And they’re also there to make sure that you get a good bang for your buck because there’s only a limited pot of money.

I had the stitches out and I started blood, started oozing through the stitches. In fact, it absolutely poured out of me, which caused me concern and that, and when I, if I go to the dentist I think to have a tooth out, I have to go to the hospital to have it out.

Do they take you off the rivaroxaban before surgery then?

They take me, they took me off the rivaroxaban, definitely took me off the rivaroxaban but it just, when they took the stitches out after my hip operation, it started pouring out of my, pouring out of the stitch holes.

And what did they do? What did they do about that?

They took, I was taken to, eventually, taken to [name of hospital], where they dressed it and it stopped bleeding eventually. It was old blood that poured out of my stitches. It wasn’t new blood.

Did they connect that at all to the rivaroxaban?

No, nobody connected to the rivaroxaban but I just, it’s just something that, something that’s crossed my mind might not, it might not be anything to do with my rivaroxaban.