ANTICOAGULANTS
You'll start hearing lots more about the comparisons between warfarin, dabigatran (Pradaxa), and rivaroxaban (Xarelto).
Now that Xarelto is approved for atrial fib, people are asking if they should switch to it or Pradaxa as an alternative to warfarin.
Help keep their pros and cons in perspective.
Efficacy is where Pradaxa may have a slight edge. Pradaxa 150 mg BID prevents about 5 more strokes per 1000 patients/year than warfarin.
Xarelto 20 mg once a day doesn't seem to work better than warfarin.
Side effects such as overall bleeding are similar between Pradaxa and Xarelto compared to warfarin. Both seem to cause FEWER intracranial bleeds...and MORE GI bleeds than warfarin.
But dyspepsia is a problem with Pradaxa.
Cost is less with warfarin...totaling about $80/month with INR monitoring once/month. Pradaxa and Xarelto both cost about $260/month.
Continue to suggest warfarin for many atrial fib patients.
Suggest another oral anticoag if INR control is poor...warfarin interactions are a concern...or monitoring isn't feasible.
If a newer anticoagulant is needed, suggest Pradaxa first...it's more effective than warfarin in some patients. Tell patients that Pradaxa is now good for 4 MONTHS after opening...instead of just 60 days.
For now, suggest Xarelto for patients who can't tolerate Pradaxa due to dyspepsia...or have trouble with its BID dosing. Advise taking Xarelto with dinner to improve absorption.
Recommend monitoring renal function with the new anticoagulants...and lowering the dose if needed.
Discourage using aspirin for atrial fib. New evidence suggests that it's not much better than placebo...and it still increases bleeding.
Suggest saving aspirin for younger patients without additional stroke risk factors...or those who won't take an anticoagulant.
If you want to be the smartest person in your area about the new anticoags for atrial fib, go to our PL Detail-Document...and listen to our experts talking on PL Voices. Also see our PL Chart, Comparison of Oral Antithrombotics, for their indications, dosing, interactions, etc.
View Detail-Document #271201
You'll start hearing lots more about the comparisons between warfarin, dabigatran (Pradaxa), and rivaroxaban (Xarelto).
Now that Xarelto is approved for atrial fib, people are asking if they should switch to it or Pradaxa as an alternative to warfarin.
Help keep their pros and cons in perspective.
Efficacy is where Pradaxa may have a slight edge. Pradaxa 150 mg BID prevents about 5 more strokes per 1000 patients/year than warfarin.
Xarelto 20 mg once a day doesn't seem to work better than warfarin.
Side effects such as overall bleeding are similar between Pradaxa and Xarelto compared to warfarin. Both seem to cause FEWER intracranial bleeds...and MORE GI bleeds than warfarin.
But dyspepsia is a problem with Pradaxa.
Cost is less with warfarin...totaling about $80/month with INR monitoring once/month. Pradaxa and Xarelto both cost about $260/month.
Continue to suggest warfarin for many atrial fib patients.
Suggest another oral anticoag if INR control is poor...warfarin interactions are a concern...or monitoring isn't feasible.
If a newer anticoagulant is needed, suggest Pradaxa first...it's more effective than warfarin in some patients. Tell patients that Pradaxa is now good for 4 MONTHS after opening...instead of just 60 days.
For now, suggest Xarelto for patients who can't tolerate Pradaxa due to dyspepsia...or have trouble with its BID dosing. Advise taking Xarelto with dinner to improve absorption.
Recommend monitoring renal function with the new anticoagulants...and lowering the dose if needed.
Discourage using aspirin for atrial fib. New evidence suggests that it's not much better than placebo...and it still increases bleeding.
Suggest saving aspirin for younger patients without additional stroke risk factors...or those who won't take an anticoagulant.
If you want to be the smartest person in your area about the new anticoags for atrial fib, go to our PL Detail-Document...and listen to our experts talking on PL Voices. Also see our PL Chart, Comparison of Oral Antithrombotics, for their indications, dosing, interactions, etc.
View Detail-Document #271201