Since the 1950s, people have had their lives extended significantly by the availability of the anti-clotting drug warfarin. It's a nasty substance by nature (still used as rat poison!), but when used wisely, provides life extension and better quality of life for many users. It has created a public health revolution by allowing many formerly "doomed" sufferers from various heart conditions to survive for many years- many achieving a normal lifespan. It doesn't have side effects like nausea or dizziness, doesn't give you a dry mouth or stop you from doing normal, everyday activities.
Both of the new drugs can also be swallowed rather than injected and they have no real side effects either. Their promoters are saying they have a huge advantage over warfarin in that their dosage doesn't need adjustment once the correct amount is worked out for you at the beginning of treatment. Warfarin has always been anxiety-provoking for doctors prescribing it because dosing is uncertain; a doctor can't say "OK, you're 75 kilos, therefore you need 5 mgs a day to stop your blood clotting inappropriately". You may need to change the dose up or down depending on what you eat or if you're on other medications. Making sure the clotting ability of your blood is reasonable, even though suppressed, can be a tricky balancing act.
Warfarin is tricky to take because it only works correctly if the clotting level of the blood is kept in a narrow range. Obviously you wouldn't want to stop the blood from clotting when you sliced your finger with the vegetable knife! However, if you had an artificial heart valve or your heart had irregular rhythm (eg. atrial fibrillation), you wouldn't want your blood to clot on its own in the spots where it wasn't flowing along fast enough- like near faulty valves or in the bottom of your heart. So sometimes people have to change their dose up and down frequently and that's inconvenient, however, if they do accidentally take more than they need, a doctor can give them some Vitamin K via injection. This usually works unless the high dose has been continued too long, when even transfusions of blood plasma might not stop the bleeding. Luckily, not many people reach this stage and there are only occasional deaths due to the medicine rather than the disease [Seventeen deaths in Australia in 5 years; hundreds would have died from their heart conditions if not on warfarin].
However, with these newly introduced drugs, Dabigatran & Rivaroxaban, there is NO ANTIDOTE a doctor can give if too much is swallowed. All they can do is cross their fingers and advise praying to your deity of choice. Meanwhile you could bleed to death or have a blood vessel burst in your brain & disable you for life.
This review claims both new medications are REVERSIBLE, just like warfarin. That's OK if there is nothing wrong with you, but if you're bleeding for some reason it takes hours for the drug to flush out of your system and allow blood to clot normally again. Saying these new drugs are "reversible" IS WRONG in my opinion because they're not instantly reversible via antidotes! Read and educate yourself if you haven't heard about the controversy.
https://www.cardiology-review.com/lessons/pdf/PER_201202-01.pdf
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