Coumadin and Pradaxa
Coumadin vs. Pradaxa for Stroke Prevention in Atrial Fibrillation:
Patients who have atrial fibrillation are at increased risk for stroke and require some form of anticoagulant with either a full dose of asprin (less effective but, less risk of bleeding), or Coumadin (more effective in preventing strokes, but increased risk of bleeding).
The CHADS 2 score was developed to determine which patients should take aspirin and which patients should take coumadin. CHADS 2 is an anacronym for the following ;
C= congestive heart failure=1 point
H= hypertension=1 point
A= age greater than 75=1 point
D= diabetes=1 point
S2= stroke or TIA= 2 points
In general, if a patient scores 0 or 1 a full dose of asprin (324 mg per/ day)is probably safer than coumadin. If the score is 2 or greater the risk of stroke is quite high and coumadin is recommended with the goal to keep the INR between 2-3.
As anyone who takes coumadin, or treats patients taking coumadin knows there are major disadvantages in taking coumadin. First, frequent blood tests and dosage adjustments makes the treatment extremely inconvenient. Second, when the INR levels fall below 2 the patients are not protected and the risk of stroke goes up, and when the INR is greater than 3 the risk of bleeding goes up with the most devastaing type being an intracranial bleed.
It is for all of these reasons that we consider the development of PRADAXA (dabigitran extexilate), which is FDA approved, to be one of the most important developments of the decade! FDA approval was given because of the very large RELY trial that compared the safety and efficacy of Pradaxa to coumadin in over 18,000 patients.
We therefore recommend, because of these results, switching patients to Pradaxa from coumadin whenever possible for the following reasons:
1. Convenience- no more blood draws for INR's and no drug dosage adjustments. It's just one pill twice a day.
2. Reduced strokes with PRADXA versus coumadin
3. Reduced bleeding with PRADAXA versus coumadin
4. Since it is effective within a few hours, patients do not need to be bridged with lovenox before leaving the hospital
since It is essentially an oral lovenox.
The major disadvantage is cost. The exact monthly cost to each patient will depend on there individual insurance plan. However, the manufacturer of the drug Boehringer Ingelheim has some assistance programs and discount cards that make the drug within reach for most patients and considering the ease of use and improved safety and efficacy, we believe it is well worth it.
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