Re: Coumadin or Warfarin---which is better?

[Guest guest]

In a message dated 12/10/2002 4:57:53 PM Pacific Standard Time,

Failteg@... writes:

<< How about the diference between Coumadin and Warfarin?

>>

I think Coumadin is Warfarin. I understand that Warfarin would be the

generic term, and Coumadin would be the brand name drug form in the same way

that Atenolol would be the generic name for the beta blocker, and Tenormin

would be the brand name, more expensive drug. Atenolol and Tenormin are

supposedly exactly the same in the way that Warfarin and Coumadin should be

the same.

in sinus in Seattle (15 minutes of afib in 202 days of straight sinus)

[Guest guest]

In a message dated 12/10/2002 4:57:53 PM Pacific Standard Time,

Failteg@... writes:

<< How about the diference between Coumadin and Warfarin?

>>

I think Coumadin is Warfarin. I understand that Warfarin would be the

generic term, and Coumadin would be the brand name drug form in the same way

that Atenolol would be the generic name for the beta blocker, and Tenormin

would be the brand name, more expensive drug. Atenolol and Tenormin are

supposedly exactly the same in the way that Warfarin and Coumadin should be

the same.

in sinus in Seattle (15 minutes of afib in 202 days of straight sinus)

[Guest guest]

In a message dated 12/10/2002 4:57:53 PM Pacific Standard Time,

Failteg@... writes:

<< How about the diference between Coumadin and Warfarin?

>>

I think Coumadin is Warfarin. I understand that Warfarin would be the

generic term, and Coumadin would be the brand name drug form in the same way

that Atenolol would be the generic name for the beta blocker, and Tenormin

would be the brand name, more expensive drug. Atenolol and Tenormin are

supposedly exactly the same in the way that Warfarin and Coumadin should be

the same.

in sinus in Seattle (15 minutes of afib in 202 days of straight sinus)

[Guest guest]

In a message dated 12/11/2002 7:16:14 AM Central Standard Time,

Failteg@... writes:

> was told by a pharmacist that Warfarin in 20%less effective than

> Coumadin (whatever that means). He went on to say that the generic

> meds are never quite the same. I had a thought that I would ask to

> be switched to Warfarin because of the cost.

>

> I would be interested in everyone's thoughts on this subject.

>

>

When I first started on anticoagulation I was put on Warfarin, but after a

couple of months my INR results began to be all over the place. I was told by

my doctor that Warfarin can be more variable than Coumadin, and he put me on

Coumadin. Since then I've have very little trouble.

Brenta

[Guest guest]

In a message dated 12/10/2002 6:57:45 PM Central Standard Time,

Failteg@... writes:

> How about the diference between Coumadin and Warfarin?

>

> Ellen

>

After I started taking amiodarone I was having a difficult time getting my

INR stablized. One day while talking to the nurse about it I mentioned that I

was taking warfarin, not coumadine which I had been taking pre amio. She was

upset, telling me that their office always insisted that their patients be

given coumadine when calling the pharmacy. Upon switching to coumadine my INR

is stablizing.

Guy

[Guest guest]

I was told by a pharmacist that Warfarin in 20%less effective than

Coumadin (whatever that means). He went on to say that the generic

meds are never quite the same. I had a thought that I would ask to

be switched to Warfarin because of the cost.

I would be interested in everyone's thoughts on this subject.

Ellen

****************

I think Coumadin is Warfarin. I understand that Warfarin would be

the generic term, and Coumadin would be the brand name drug form

(snip)

*****************

[Guest guest]

Dear Ellen,

Good point. I'll change that to show that warfarin is the generic

name, Coumadine the brand name. Thanks.

A-FibFriendSteve

Ellen Gilmartin wrote:

>How about the diference between Coumadin and Warfarin?

>

>Ellen

>****************

> ----- Original Message -----

>

>

>

> (snip) " Which is the better anticoagulant to prevent stroke---warfarin

> (Coumadine) or aspirin? " (snip)

>

>

>

>

[Guest guest]

In a message dated 12/11/2002 5:16:14 AM Pacific Standard Time,

Failteg@... writes:

<< He went on to say that the generic

meds are never quite the same. I had a thought that I would ask to

be switched to Warfarin because of the cost. >>

From personal experience, I can believe that generic meds are never quite the

same, even though numerous pharmacists have argued with me that they should

be the same. I found, for example, back in the days about four years ago

when I was taking only 25 m.g. of Tenormin (brand name) daily and was given

Atenolol as a substitute by the pharmacist, that the Atenolol was definitely

not as effective in preventing ectopic beats. I only had afib about three to

six times a year at that point but frequently had tachycardia and ectopic

beats. The Atenolol just did not seem to do the same job of controlling the

problem as did the Tenormin. The pharmacist wouldn't believe me, but I had

my doctor specify that the prescription should be for Tenormin only. On

another occasion, when I was assured that the generic and brand name drugs

for treating an eye infection were the same, I read the ingredient list for

both and discovered that the generic eye drops contained Thimerosol, to which

I am quite allergic. There were other slight differences, also. Again, the

pharmacist had assured me that the generic and brand name drugs were the

same. I think that one must be careful about substituting generic for brand

name drugs. The effectiveness probably varies from person to person, also.

in sinus in Seattle ( 15 minutes of afib in 203 days of straight sinus)

[Guest guest]

In a message dated 12/11/2002 5:16:14 AM Pacific Standard Time,

Failteg@... writes:

<< He went on to say that the generic

meds are never quite the same. I had a thought that I would ask to

be switched to Warfarin because of the cost. >>

From personal experience, I can believe that generic meds are never quite the

same, even though numerous pharmacists have argued with me that they should

be the same. I found, for example, back in the days about four years ago

when I was taking only 25 m.g. of Tenormin (brand name) daily and was given

Atenolol as a substitute by the pharmacist, that the Atenolol was definitely

not as effective in preventing ectopic beats. I only had afib about three to

six times a year at that point but frequently had tachycardia and ectopic

beats. The Atenolol just did not seem to do the same job of controlling the

problem as did the Tenormin. The pharmacist wouldn't believe me, but I had

my doctor specify that the prescription should be for Tenormin only. On

another occasion, when I was assured that the generic and brand name drugs

for treating an eye infection were the same, I read the ingredient list for

both and discovered that the generic eye drops contained Thimerosol, to which

I am quite allergic. There were other slight differences, also. Again, the

pharmacist had assured me that the generic and brand name drugs were the

same. I think that one must be careful about substituting generic for brand

name drugs. The effectiveness probably varies from person to person, also.

in sinus in Seattle ( 15 minutes of afib in 203 days of straight sinus)

[Guest guest]

In a message dated 12/11/2002 5:16:14 AM Pacific Standard Time,

Failteg@... writes:

<< He went on to say that the generic

meds are never quite the same. I had a thought that I would ask to

be switched to Warfarin because of the cost. >>

From personal experience, I can believe that generic meds are never quite the

same, even though numerous pharmacists have argued with me that they should

be the same. I found, for example, back in the days about four years ago

when I was taking only 25 m.g. of Tenormin (brand name) daily and was given

Atenolol as a substitute by the pharmacist, that the Atenolol was definitely

not as effective in preventing ectopic beats. I only had afib about three to

six times a year at that point but frequently had tachycardia and ectopic

beats. The Atenolol just did not seem to do the same job of controlling the

problem as did the Tenormin. The pharmacist wouldn't believe me, but I had

my doctor specify that the prescription should be for Tenormin only. On

another occasion, when I was assured that the generic and brand name drugs

for treating an eye infection were the same, I read the ingredient list for

both and discovered that the generic eye drops contained Thimerosol, to which

I am quite allergic. There were other slight differences, also. Again, the

pharmacist had assured me that the generic and brand name drugs were the

same. I think that one must be careful about substituting generic for brand

name drugs. The effectiveness probably varies from person to person, also.

in sinus in Seattle ( 15 minutes of afib in 203 days of straight sinus)

[Guest guest]

>

>

>Warfarin is the only and best !! Not a friendly

>drug, but according to the Heart Association there is a

>88% chance of NOT having a stroke with a-fib compared

>to 8% for aspirin.Take the odds !!

>

These are very important odds. I'll use them in the A-Fib.com Web site.

Can you help me find them on the Am. Heart Assoc. Web site or in their

publications so I can give the reference? Thanks.

A-FibFriendSteve

[Guest guest]

>

>

>Warfarin is the only and best !! Not a friendly

>drug, but according to the Heart Association there is a

>88% chance of NOT having a stroke with a-fib compared

>to 8% for aspirin.Take the odds !!

>

These are very important odds. I'll use them in the A-Fib.com Web site.

Can you help me find them on the Am. Heart Assoc. Web site or in their

publications so I can give the reference? Thanks.

A-FibFriendSteve

[Guest guest]

>

>

>Warfarin is the only and best !! Not a friendly

>drug, but according to the Heart Association there is a

>88% chance of NOT having a stroke with a-fib compared

>to 8% for aspirin.Take the odds !!

>

These are very important odds. I'll use them in the A-Fib.com Web site.

Can you help me find them on the Am. Heart Assoc. Web site or in their

publications so I can give the reference? Thanks.

A-FibFriendSteve

[Guest guest]

<<Warfarin is the only and best !! Not a friendly

drug,but according to the Heart Association there is a

88% chance of NOT having a stroke with a-fib compared

to 8% for aspirin.Take the odds !!>>

Sorry coolsnake but yet again you have posted some crazy statistics without

any links to back them up.

I DO NOT have a 92% chance of having a stroke because I take aspirin!

I believe the current figures for warfarin are a risk REDUCTION of around 61%

(see

http://www.acc.org/clinical/guidelines/atrial_fib/VIII_management.htm#VIII_G)

please note I'm shouting REDUCTION.

So for an AFibber with a yearly risk of about 2.8% (perhaps a 70 year old

with hypertension - but please don't take this as being true!)

they can reduce the yearly risk to just over 1% by taking warfarin.

I'm sorry to get annoyed and I'm sure I've posted some misleading information

before now and I'm sure you haven't intentionally set out to mislead anyone.

If you are uncomfortable about statistics it may be better not to post any

numbers to a public forum.

It just goes to show that no-one should believe a word anyone reads on the

internet without backing it up with personal research.

That includes the content of this email.

Please - please - please don't take my word for it.

I don't want to come across as the only right opinion is my own and I welcome

constructive argument and disagreement. Please disagree with me, you'll have

a much better chance of changing my mind if you can point me at research to

back your arguments up.

--

D

[Guest guest]

<<Warfarin is the only and best !! Not a friendly

drug,but according to the Heart Association there is a

88% chance of NOT having a stroke with a-fib compared

to 8% for aspirin.Take the odds !!>>

Sorry coolsnake but yet again you have posted some crazy statistics without

any links to back them up.

I DO NOT have a 92% chance of having a stroke because I take aspirin!

I believe the current figures for warfarin are a risk REDUCTION of around 61%

(see

http://www.acc.org/clinical/guidelines/atrial_fib/VIII_management.htm#VIII_G)

please note I'm shouting REDUCTION.

So for an AFibber with a yearly risk of about 2.8% (perhaps a 70 year old

with hypertension - but please don't take this as being true!)

they can reduce the yearly risk to just over 1% by taking warfarin.

I'm sorry to get annoyed and I'm sure I've posted some misleading information

before now and I'm sure you haven't intentionally set out to mislead anyone.

If you are uncomfortable about statistics it may be better not to post any

numbers to a public forum.

It just goes to show that no-one should believe a word anyone reads on the

internet without backing it up with personal research.

That includes the content of this email.

Please - please - please don't take my word for it.

I don't want to come across as the only right opinion is my own and I welcome

constructive argument and disagreement. Please disagree with me, you'll have

a much better chance of changing my mind if you can point me at research to

back your arguments up.

--

D

[Guest guest]

<<Warfarin is the only and best !! Not a friendly

drug,but according to the Heart Association there is a

88% chance of NOT having a stroke with a-fib compared

to 8% for aspirin.Take the odds !!>>

Sorry coolsnake but yet again you have posted some crazy statistics without

any links to back them up.

I DO NOT have a 92% chance of having a stroke because I take aspirin!

I believe the current figures for warfarin are a risk REDUCTION of around 61%

(see

http://www.acc.org/clinical/guidelines/atrial_fib/VIII_management.htm#VIII_G)

please note I'm shouting REDUCTION.

So for an AFibber with a yearly risk of about 2.8% (perhaps a 70 year old

with hypertension - but please don't take this as being true!)

they can reduce the yearly risk to just over 1% by taking warfarin.

I'm sorry to get annoyed and I'm sure I've posted some misleading information

before now and I'm sure you haven't intentionally set out to mislead anyone.

If you are uncomfortable about statistics it may be better not to post any

numbers to a public forum.

It just goes to show that no-one should believe a word anyone reads on the

internet without backing it up with personal research.

That includes the content of this email.

Please - please - please don't take my word for it.

I don't want to come across as the only right opinion is my own and I welcome

constructive argument and disagreement. Please disagree with me, you'll have

a much better chance of changing my mind if you can point me at research to

back your arguments up.

--

D

[Guest guest]

Hi,

the odds for people on aspirin are a little better than that

according to my reads, but they are all questionable, so I don't

mention them. Warfarin/Coumadin is a greater protector, I am sure we

all agree here.

Afib by itself is only partially responsible for clots, many other

heart conditions have an effect on clot formation and they will

determine what your chances are of having a stroke.

Just read another article: To reduce your risk of heart attack or

stroke drink plenty of water, keeping your blood thin (the natural

way I guess) lowers your risk of developing heart attack -

triggering blood clots.

/

>

> <<Warfarin is the only and best !! Not a friendly

> drug,but according to the Heart Association there is a

> 88% chance of NOT having a stroke with a-fib compared

> to 8% for aspirin.Take the odds !!>>

>

> Sorry coolsnake but yet again you have posted some crazy statistics

without

> any links to back them up.

> I DO NOT have a 92% chance of having a stroke because I take

aspirin!

>

[Guest guest]

wrote

<<Hi,

the odds for people on aspirin are a little better than that

according to my reads, but they are all questionable, so I don't

mention them. Warfarin/Coumadin is a greater protector, I am sure we

all agree here. >>

Hi , although I see where you are coming from I'm afraid I still

disagree.

Yes the research into the protection aspirin provides seems to come out on

the side of there's little benefit.

Yes there's a large group of people who have AF where taking warfarin will

reduce the risk of stroke (some will be able to reduce the risk by more than

half).

But, and it is a very big but, for some people with AF the greater protector

is not to take warfarin. I know this may sound a little controversial and I'm

certainly not suggesting that warfarin should be avoided at all costs but

there is a risk:benefit ratio to consider. It is a very individual problem

but the risks of taking warfarin (or aspirin) must be considered along with

their benefits. If your risk of having a stroke is going to go up by taking

warfarin then it seems to me you are better off not taking it.

Just my view - I know it's not shared by all.

--

D (taking 75mg of enteric coated aspirin a day but it doesn't mean that

you should too

[Guest guest]

Hi ,

I am always willing to learn. Are you saying, Warfarin can increase

your risk of stroke? I know of brain hemorrhaging that is increased

by Warfarin (and therefore not recommended) and the reason one of my

docs switches older patients to Aspirin.

/

.. If your risk of having a stroke is going to go up by taking

> warfarin then it seems to me you are better off not taking it.

>

> Just my view - I know it's not shared by all.

> --

> D (taking 75mg of enteric coated aspirin a day but it doesn't

mean that

> you should too

[Guest guest]

<<Hi ,

I am always willing to learn. Are you saying, Warfarin can increase

your risk of stroke? I know of brain hemorrhaging that is increased

by Warfarin (and therefore not recommended) and the reason one of my

docs switches older patients to Aspirin.>>

Hi

as Brenta as already mentioned by taking warfarin you increase the risk of

haemorrhagic stroke. You also decrease the risk of ischaemic stroke.

AF (along with other risk factors) increase the chances of an embolic stroke

(ischaemic).

What's important is what happens to the overall risk of stroke (of either

kind).

If it goes down by taking warfarin then warfarin is a good choice - if it

goes up then it's not such a good idea.

Your average healthy person still has a risk of stroke but they don't take

warfarin because the risk of a haemorrhagic stroke out-weighs the benefit of

ischaemic prevention. Some people with AF have a remarkably similar risk to

the general population and so warfarin is not a good choice for them.

It has to be said that trying to figure out where you are on the risk:benefit

scale is very hard. (and it's not a static decision).

A good talk with a good doctor is really what's needed to work out your

individual situation.

All the best

--

D

[Guest guest]

<<Hi ,

I am always willing to learn. Are you saying, Warfarin can increase

your risk of stroke? I know of brain hemorrhaging that is increased

by Warfarin (and therefore not recommended) and the reason one of my

docs switches older patients to Aspirin.>>

Hi

as Brenta as already mentioned by taking warfarin you increase the risk of

haemorrhagic stroke. You also decrease the risk of ischaemic stroke.

AF (along with other risk factors) increase the chances of an embolic stroke

(ischaemic).

What's important is what happens to the overall risk of stroke (of either

kind).

If it goes down by taking warfarin then warfarin is a good choice - if it

goes up then it's not such a good idea.

Your average healthy person still has a risk of stroke but they don't take

warfarin because the risk of a haemorrhagic stroke out-weighs the benefit of

ischaemic prevention. Some people with AF have a remarkably similar risk to

the general population and so warfarin is not a good choice for them.

It has to be said that trying to figure out where you are on the risk:benefit

scale is very hard. (and it's not a static decision).

A good talk with a good doctor is really what's needed to work out your

individual situation.

All the best

--

D

[Guest guest]

<<Hi ,

I am always willing to learn. Are you saying, Warfarin can increase

your risk of stroke? I know of brain hemorrhaging that is increased

by Warfarin (and therefore not recommended) and the reason one of my

docs switches older patients to Aspirin.>>

Hi

as Brenta as already mentioned by taking warfarin you increase the risk of

haemorrhagic stroke. You also decrease the risk of ischaemic stroke.

AF (along with other risk factors) increase the chances of an embolic stroke

(ischaemic).

What's important is what happens to the overall risk of stroke (of either

kind).

If it goes down by taking warfarin then warfarin is a good choice - if it

goes up then it's not such a good idea.

Your average healthy person still has a risk of stroke but they don't take

warfarin because the risk of a haemorrhagic stroke out-weighs the benefit of

ischaemic prevention. Some people with AF have a remarkably similar risk to

the general population and so warfarin is not a good choice for them.

It has to be said that trying to figure out where you are on the risk:benefit

scale is very hard. (and it's not a static decision).

A good talk with a good doctor is really what's needed to work out your

individual situation.

All the best

--

D

[Guest guest]

In a message dated 12/12/2002 7:25:44 AM Pacific Standard Time,

james@... writes:

<< It is a very individual problem

but the risks of taking warfarin (or aspirin) must be considered along with

their benefits. If your risk of having a stroke is going to go up by taking

warfarin then it seems to me you are better off not taking it.

>>

I think that the history of the individual patient and mindset of his or her

doctor has a lot to do with the decision, too. My older brother in permanent

afib for at least twenty years has never taken Coumadin or Warfarin, and he

has never had a stroke. His doctor feels that with that history, he doesn't

need Coumadin because it seems that he would have suffered a stroke when he

was bouncing in and out of afib if he were a stroke candidate. My brother's

doctor believes that a person in permanent afib has less stroke risk than a

paroxysmal afibber like me, who has bounced in an out of afib so frequently.

When my brother decided on his own to start taking an aspirin a day, his

doctor felt he didn't need that but said it wouldn't hurt.

My brother's doctor is not a cardiologist but a gastroenterologist because my

brother initially thought when he was seeking a doctor that the problem was

with his stomach, not his heart. His doctor asked my brother if he would

like to see a cardiologist, but my brother told him he is very satisfied with

the treatment he is receiving and sees no need to switch doctors. When I

mentioned to my cardiologist that I have an older brother in permanent afib,

his first response was a question: " Is he on Coumadin? " When I said no, he

just shook his head. Perhaps this might indicate that some cardiologists may

be more prone to prescribe Coumadin than other specialists might be. Of

course, this also may be an overgeneralization because one case does not

valid statistics make, but it's an interesting thought and different

perspective.

in sinus in Seattle (15 minutes of afib in 204 days of sinus)

[Guest guest]

wrote:

<<I think that the history of the individual patient and mindset of his or

her

doctor has a lot to do with the decision, too. [snip] Of

course, this also may be an overgeneralization because one case does not

valid statistics make, but it's an interesting thought and different

perspective.>>

I think you are right and it is borne out by some statistics.. see the

posts a while back thst point to research that

15% to 25% patients aged < 75 years who did not meet clinical and/or

echocardiographic criteria for eligibility were being

anticoagulated.

I think new information takes time to filter through the system and some

doctors are perhaps reluctant to change something they have been practicing

(perhaps successfully) for many years.

There's a serious case of information overload for the doctors and many will

stick with what they think works. I think it's almost impossible to be up to

date on all the research that comes out (even for the specialist doctors).

It's also wrong of us to assume that the best thing a doctor can do is change

with every new article that is published. The lag in many ways in no bad

thing and is all part of the evolution of medicine.

Hey - an email that's almost supporting doctors

(ok an email that supports doctors who do keep up to date and make slow

changes because of what they read)

--

D