If it ain't broke!

             My Atria started fibrillating when I was about 45 years old.    Everyone in  the medical world knew that atrial fibrillation, erratic contraction of the atrial chambers of the heart  was a very definite marker for stroke.   The cause being that the uneven contractions allow clots to form in the atria, from whence they throw off fragments that block the small blood vessels and cut off the blood supply.  If that happens in  the brain it causes a stroke.  I was started on warfarin, a blood thinner, that was formerly used as a rat poison.  This tended to stop clots from  forming, the disadvantage being that if it is too anti coagulated the blood doesn't clot when  it needs to, putting the  patient at risk for increased bleeding of various intensity, from  mild bleeding to death.  Monthly blood tests ensure that the blood  is not too anti-coagulated and the dosage is regulated accordingly.  If the  patient is bleeding excessively, the effects of the warfarin can be quickly reversed by Vitamin K orally or intravenously.  It's a bit of a nuisance having a monthly blood test, so that despite the fact that warfarin is very effective, the search for a replacement that does not need blood testing has been intense.  Even minor inconveniences are unacceptable these days.
    Along came the new oral anticoagulants (NOACs).  . Things have changed dramatically with the introduction of the new oral anticoagulants (NOACs)—dabigatran, a factor IIa (thrombin) inhibitor, and the factor Xa inhibitors rivaroxaban and apixaban. Clinical trials have shown them  non-inferior, to VKAs (warfarin).  The fact that they don't require the monthly INR or clotting test that warfarin does, makes them very attractive to many patients.  Unfortunately, they do not have any antidote that will rapidly restore the 'clottability' of the blood, which may have dire consequences.   They are, of course much more expensive than warfarin and are being pushed hard and advertised to the public by 'Big Pharma'.    Despite their convenience, when my medical adviser offered me the option, I opted to continue  on warfarin, convinced that  it is the better option.
      I will  sum up with a conversation I  had with a Wise  Little Old Lady just before I retired.
      She said, "Doctor, the specialist wanted to change me to a new blood thinning pill so I wouldn't have to come in for a blood test every few weeks.  I said no."
       Me, "why was  that?"
        Pt., "When I asked him how he would  know how thin my blood was and what dose to  give me  He said it wasn't necessary to know.  Then  he told me if my blood was too thin there was no way to reverse it.   So  I  told him they had no right to sell it before they had a way to reverse it and that I'd stay on my warfarin and have my blood tests."
         I think the Wise Little Old Lady was smarter than the doctor!
         The search for an antidote to the NOACs continues.