Anticoagulant $50 injections

[Jerry_NJ]

I am a long time user of Warfarin anticoagulant because of my AFib condition.  The generic Warfarin cost about $10 (Walmart for example) for a 90 supply.

My wife recently had major surgery to remove cancerous organs and is required to take a daily anticoagulant for 30 days.  In her case it is injected by syringe and each Cost about $50, throw away devices.  That a whopping $1,500 for 30 days.  Happily we have prescription insurance and her deductible had already been reached, so our out-of-pocket is much less than the list price.  Still I wonder...  

Anyone know why the surgeon would prescribe this very expensive form of anticoagulant when oral administered warfarin is very inexpensive and doesn't require sticking oneself with a needle?  I suppose it is more effective - I'll ask him myself if I ever see him again.

[Janpes]

Hahahaha me no drink and drive...lol

Can't wait until my warfarin sentence is up so I can hopefully enjoy a glass of Chardonnay, haven't had any alcohol since last boxing day when all these problems started :(
Only 2½ weeks of warfarin left ...YIPPPEEEE!!!!

[Jerry_NJ]

Right, laprascopic, I have a problem with words longer than four letters.  I think I had a endoscopic heart echo in the build up to my heart surgery in 2007, and that word got associated with getting into one's body through small holes.

I read you profile and philosophy on life and death.  Sounds good to me, but be careful on "Chardonnay in one hand - chocolate in the other" if you are driving a car ;)

[Janpes]

The gallbladder surgery is nowadays done laprascopic, only need the full surgery if there are problems. I think that my surgeon said that 99% of gallbladder surgeries are started laproscopically, so that means 1% end up being full surgery.

I also had laproscopic surgery and would have been great if I hadn't had a DVT a week later.
The injections of heparin have a short life of either 12 hours or 24 hours so it is important to inject at the same time every day.
I injected at 8am and 8pm everyday for 2 weeks. It is a pain and also the stomach area looks terrible filled with bruises all the time.
As the Heparin as a short life there is no need to take daily/ weekly or monthly blood tests, and there is as you mentioned no interaction with vitamin K.
The only difference over here is the price.... about 90 euro for a box of 10, after using my social card then about 50 euro's is usually left to pay, whereas Warfarin costs about 5 euros for 100 pills.

[Jerry_NJ]

Thanks for your experiences.  This gives me a reference saying it isn't unusual, albeit my wife had her gallbladder removed a year of so back, and it was done robotic methods, endoscopic it think it is called.  So the trauma was minimal.  The subject surgery was done to remove cancer infected organs, so it was a full frontal entry, very large opening and a lot of removal so there is a lot of healing going on.

It isn't clear to me why injections would "automatically" cause achievement of the needed INR level range.  Perhaps injections somehow avoid the problem of vitamin K ingestion via diet.  It does seem "intuitive" that injections would be faster acting.

As I said we have insurance coverage and the cost for us is paying the deductible each year.  We are older folks so we both have regular prescription medications and about the middle of the year prescriptions get close to "free", that is the co-payment is about 10% of the cost.   In the case of the injections we had to pay out-of-pocket about 2% of the cost.  Still, I look for cost justification as I know nothing is "free" , it is all a matter of how it is paid for.  

[Janpes]

If she only has to take it the 30 days it is easier with the injections.
As you know warfarin is a very unpredictable drug which does take some time to get up to theraputic level. Until she is theraputic she would have to take the injections as well as the warfarin to reach the required level (2-3) Also by using the injections it eliminates the need for INR tests every second day. No need to follow the injections via blood tests.

I myself am on warfarin due to a DVT after gallbladder surgery in April this year.
Took 2 weeks of twice daily injections until I was theraputic and almost daily blood tests. The injections cost 5€ each.
It is good that I was on the warfaring after the ablation too, no need to go through the rumba of starting up again and injecting.

Hope your wife starts to feel better soon
Take care
Jan