Pradaxa

[debster913]

Hi, all--

Because of all my A-Fib fun, my cardio has put me on Pradaxa 150 mg daily. I started today, and I felt nauseated for a couple hours. Hopefully that will pass once my body gets used to it. (The cardio took me off an aspirin regimen and replaced that now with the new drug).

Anyone else here on Pradaxa? Thoughts?

If this doesn't work for me...the next stop is coumadin (and I thought I was safe from coumadin when I had my valve repaired, not replaced!)

Thanks,
Debi

 

[Lynlw]

Hi, all--

Because of all my A-Fib fun, my cardio has put me on Pradaxa 150 mg daily. I started today, and I felt nauseated for a couple hours. Hopefully that will pass once my body gets used to it. (The cardio took me off an aspirin regimen and replaced that now with the new drug).

Anyone else here on Pradaxa? Thoughts?

If this doesn't work for me...the next stop is coumadin (and I thought I was safe from coumadin when I had my valve repaired, not replaced!)

Thanks,
Debi

I hope it works well. I was just (a couple minutes ago) reading an article on the new "updated" guidelines for Afib, that might interest you
http://www.theheart.org/article/116...medium=email&utm_source=20101223_EN_Heartwire
"US societies bring atrial-fib guidelines almost up-to-date
December 23, 2010 | Steve Stiles"

..."The document from the American College of Cardiology (ACC), American Heart Association (AHA), and Heart Rhythm Society (HRS), which updates guidelines published in 2006 [2], was released December 20, 2010 on the organizations' respective websites and will be published in their flagship journals. It follows publication of new AF guidelines from the Canadian Cardiovascular Society (CCS) in September and the European Society of Cardiology (ESC) in October, as reported by heartwire."...


They mention that they already will be updating then, hopefully in the beginning of the year, because of Pradaxa being approved.

"Now that the drug is approved, he said, they can go with plan B: since the dabigatran part has already been finalized, they will release an update to the update. "That is in the final process of being approved by all the boards of the ACC and AHA, and I believe will be out soon after the first of the year."

The dabigatran recommendations will be simple, according to Wann. Indications for oral anticoagulation in AF haven't changed, so "the way the guideline will read is that dabigatran substitutes for warfarin except in patients with valvular heart disease. Otherwise, obey the same rules that you'd obey for warfarin. If you'd start a patient on warfarin, you'd start them on dabigatran. The evidence that it prevents strokes at least as well as warfarin is quite convincing, and the updated guideline will reflect that."

Wann acknowledges that the availability of dabigatran steals some of the thunder from one of the new update's recommendations, that the combination of aspirin and clopidogrel (Plavix, Sanofi-Aventis/Bristol-Myers Squibb) "might be considered" to cut the risk of stroke and other vascular events as an alternative to warfarin (class IIb, level of evidence B).

Many patients with AF who might have gone with the double-antiplatelet therapy instead of warfarin now have the dabigatran option, he observed, so the importance of aspirin-clopidogrel "will pale in comparison with the impact that dabigatran will have on the oral anticoagulation scene."

 

[Duff Man]

My thoughts? It's a very new drug they put you on. Probably expensive too.

http://en.wikipedia.org/wiki/Dabigatran

 

[Protimenow]

You said that you 'thoiught you were safe' from coumadin. Warfarin has gotten a lot of bad press - and your suggestion that warfarin was inherently 'unsafe' reflects that.

From what I understand, Pradaxa costs about $8 a day. Compare that to 10 or 20 cents a day for warfarin. Although anybody's health isn't calculated based on dollars and cents, warfarin has been used for a-fib for decades - with few reported calamities.

You may want to ask your doctor how many free dinners he or she went to when Pradaxa was first approved.

To me, if Pradaxa WAS approved for AVR, I'm still not sure that I would want to spend $56 or so per week just to possibly avoid a weekly (or less) finger prick and INR test. PLUS - warfarin has a long history of successful management. I would almost absolutely stay with warfarin unless there was a compelling reason not to.

 

[ALCapshaw2]

Ask your Doc what he would do if you developed a Bleeding Issue while on Pradaxa.
Is there an antidote? (I don't think so but will have to double check...)

 

[Jkm7]

What would the doctor do if a patient developed bleeding while taking Plavix?

Is there an antidote?

I have looked and while I admit to being less than stunningly able at research, it seems Plavix has no antidote yet
millions of patients take it daily.


Debster.... I hope the pradaxa works well for you. Best Wishes. Please let us know how it goes.

 

[debster913]

You said that you 'thoiught you were safe' from coumadin. Warfarin has gotten a lot of bad press - and your suggestion that warfarin was inherently 'unsafe' reflects that.

From what I understand, Pradaxa costs about $8 a day. Compare that to 10 or 20 cents a day for warfarin. Although anybody's health isn't calculated based on dollars and cents, warfarin has been used for a-fib for decades - with few reported calamities.

You may want to ask your doctor how many free dinners he or she went to when Pradaxa was first approved.

To me, if Pradaxa WAS approved for AVR, I'm still not sure that I would want to spend $56 or so per week just to possibly avoid a weekly (or less) finger prick and INR test. PLUS - warfarin has a long history of successful management. I would almost absolutely stay with warfarin unless there was a compelling reason not to.

Protimenow:
Before you jump down my throat about any "implication" in my post, let me clarify:

When I said that I thought I'd "be safe" from warfarin, I meant that I never thought I would NEED an anticoagulant because of my surgery. I was on warfarin for six weeks following my surgery. My grandmother was on warfarin therapy herself for many years after she'd had a stroke, and it was very effective. I am by no means, as you suggest, saying that warfarin is no good.

FWIW, Now that my cardio's nurse has just called me in inform me that I will be spending $65 out of pocket for Pradaxa monthly, as well as the $78 I am already spending on Multaq, I am likely better off on warfarin.

What's this also, about no antidote? If I get a bleed I'm screwed? Great. I just want to learn as much as I can about this drug.

 

[Bina]

Deb, even if you do end up needing Coumadin/warfarin, you know us well enough to know that we would help
you out anytime. Take a deep breath hon.

 

[debster913]

Deb, even if you do end up needing Coumadin/warfarin, you know us well enough to know that we would help
you out anytime. Take a deep breath hon.

Thanks, Bina! I can always count on you for a calm perspective!

The more I've been reading about Pradaxa (FDA website, etc.), the less I like it. Um, Coumadin, here I come. Looks like I'll be joining the ranks of all you good people!

 

[Jkm7]

Debster,
If these drugs (pradaxa and plavix etc) were so dangerous and risky there would not be the millions of patients taking it in U.S. let alone around the world.

To say 'no antidote' doesn't begin to explain available treatments for a 'bleed'.

Also, when comparing costs, don't forget to include the cost of weekly (or periodic) INR testing when doing calculations.

Your doctors and you are far more able to decide what is best for your distinct case than any of us here.

Best wishes.

 

[Duff Man]

I think it's an exciting new drug with a lot of potential up sides - the problem is that it's so new. Compared with other mainstay ACTs, it has a lot of unknowns. Many of these new anticoagulants that've come out recently have been discontinued for liver damage, etc. I didn't want to say anything in my first post to dissuade you from what a doctor obviously thinks is best for you, but I personally would not take the drug - for both economical reasons and safety precautions. It's a lot of money to take something that isn't as proven as, say, coumadin. The medical community knows coumadin pretty well now.... alot better than Pradaxa, at least.

I myself doubt that it's dangerous, and in fact it's probably safe for most judging just by the sheer numbers of people taking itand the fact that it hasn't been on the news as killing people yet... but I think the cost of the drug and the fact that it's not as proven make it kind of a riskier choice.

 

[Philip B]

Bumps

Bumps

Hi Deb,

Sorry to hear that you've encountered a bump. Good luck with the new meds... hope the new stuff works well for you. If you end-up being a coumadin junkie, you'll be in good company

-Philip

 

[Protimenow]

NO, no intention to 'jump down your throat.' It was the wording that made it seem like you thought warfarin was some kind of scourge

(Also, I think I'm somewhat sensitive to another thread where one of the people on the thread seems to think that it may be safer to NOT take warfarin at all than to take that 'rat poison.' Perhaps I'm defending warfarin a bit more than is reasonable)

As far as JKM7's comment about the cost of INR testing being included in calculating the cost of warfarin -- good point, but I think I already mentioned that. INR testing - even if done weekly - is probably less than $10 a week (especially if home testing). Some of this depends on insurance coverage.

In fact, a lot depends on how much insurance will pay for Pradaxa versus how much they'll pay for warfarin and INR testing (if you have insurance, of course).

If it was a choice for me, I'd probably gladly stick with warfarin and my own regular testing.

 

[ALCapshaw2]

Protimenow:
Before you jump down my throat about any "implication" in my post, let me clarify:

When I said that I thought I'd "be safe" from warfarin, I meant that I never thought I would NEED an anticoagulant because of my surgery. I was on warfarin for six weeks following my surgery. My grandmother was on warfarin therapy herself for many years after she'd had a stroke, and it was very effective. I am by no means, as you suggest, saying that warfarin is no good.

FWIW, Now that my cardio's nurse has just called me in inform me that I will be spending $65 out of pocket for Pradaxa monthly, as well as the $78 I am already spending on Multaq, I am likely better off on warfarin.

What's this also, about no antidote? If I get a bleed I'm screwed? Great. I just want to learn as much as I can about this drug.

Debi -

If you are interested in lowering the costs of medication to treat your A-Fib, you might want to discuss SOTALOL (generic for Betapace) with your Doctor. Sotalol is available for $4/30 or $10/90 at Walmart, CVS, and other pharmacies.
Several of our members report good control (i.e. prevention) of A-Fib with Sotalol.

You might also want to see if there is a dedicated Coumadin Clinic in your area (see www.acforum.com).
Coumadin Clinic nurses are usually well trained and see enough patients to know how they react to dosing changes.
(The 4 CRNP's at my clinic manage 3000 anticoagulation patients - 60+% A-Fib, 20+% DVT, 10% Mechanical Heart Valves).
Most insurance covers the cost of INR testing. (I've never had to pay anything for an INR test).
Warfarin Cost $4/30 or $10/90 at Walmart, CVS, and other pharmacies.

 

[kfay]

NO, no intention to 'jump down your throat.' It was the wording that made it seem like you thought warfarin was some kind of scourge

(Also, I think I'm somewhat sensitive to another thread where one of the people on the thread seems to think that it may be safer to NOT take warfarin at all than to take that 'rat poison.' Perhaps I'm defending warfarin a bit more than is reasonable)

As far as JKM7's comment about the cost of INR testing being included n calculating the cost of warfarin -- good point, but I think I already mentioned that. INR testing - even if done weekly - is probably less than $10 a week (especially if home testing). Some of this depends on insurance coverage.

In fact, a lot depends on how much insurance will pay for Pradaxa versus how much they'll pay for warfarin and INR testing (if you have insurance, of course).

If it was a choice for me, I'd probably gladly stick with warfarin and my own regular testing.

It may not have been "your intention" to jump down Debi's throat, but that's certainly how you came across to me. I'm not sure why you seem to care so much about coumadin and what other people's thoughts are, whether negative or positive, you'd almost think you have a personal financial stake in it. Also, why do you care what people are willing to spend on an anti-coag med?

Are you also kidding when you say that in decades there have only been a few reported calamities caused by coumadin? I find this statement very hard to believe. In decades??? Really? Do you have documentation to back this up?

I really don't have a problem with coumadin. I've only had 6 months worth of experience with it, but didn't have any problems with it during that time period. However, I find your extreme style (boarding obsessive) of posting about coumadin and home testing and buying equipment on e-bay a huge turn off and almost offensive.

By the way Debi, I think you'll do fine on coumadin. I'm sorry you are still in A-fib. I hope they can find a way to fix that so you don't have to deal with all of this. Is there a chance of an ablation?

Kim

 

[Protimenow]

I have absolutely no personal financial stake in warfarin -- I don't see how that is even possible -- it's a generic drug, available for about a dime a pill and I don't think anyone is getting rich on it.
I care about what people pay for anticoagulation drugs because I haven't had much money for the past few years and it is important TO ME that effective management can be done affordably. I don't like to see others spend more than they should on medications or equipment when an appropriate alternative will do practically the same job. It's called empathy.

I don't think my postings about warfarin are more extreme than those of others here -- I'm a proponent of warfarin because it works. I've also written about Pardaxa and other anticoagulants in develoment, and mentioned that they may become important in the next few years - and may even eventually replace warfarin. How is this not balanced?

As far as home testing and buying equipment on e-Bay are concerned -- for me, I had few alternatives -- without insurance and a healty bank balance I could either do self testing (with a meter I bought affordably) or occasionally get tested and hope for the best. There are others here who neither have the insurance nor the wherewithal to get their own meters for full retail.

For me, this is a public health issue. There ARE people here who apparently neither had the insurance they needed to get a meter using that avenue - and who were actually grateful to learn about my experience with meters bought from secondary sources. For them, they may have had the few alternatives that I had -- and to enable them to do self-testing is a tremendous gift. Without exaggeration, empowering them to self test -- even if they use a meter that wasn't bought from an authorized distributor - could be, literally, life saving. If my postings about this border on obsessive - I may be guilty as charged - I don't want to see finances getting in the way of regular self-testing and monitoring.

In the future, if you don't like my posts, just skip over them.

As far as 'calamities' - there are many recent reports that say that home testing has significantly improved in range INRs and reduced the number of 'events' that result from out of range INRs. There ARE issues related to mismanaged or undermanaged anticoagulation - and I wasn't referring to these - for people regularly tested, who stay within range, and who don't have other bleeding problems (ulcers, for example), the ability to test has prolonged many lives.

 

[Jkm7]

As far as 'calamities' - there are many recent reports that say that home testing has significantly improved in range INRs and reduced the number of 'events' that result from out of range INRs. There ARE issues related to mismanaged or undermanaged anticoagulation - and I wasn't referring to these - for people regularly tested, who stay within range, and who don't have other bleeding problems (ulcers, for example), the ability to test has prolonged many lives.

You may have read here on these boards that not all coumadin patients are being given approval by their doctors to do home testing. We read here all the time that a Valver has asked their doctors to complete the forms and they refuse.

Until and unless told to stop expressing my opinion, I shall continue but I've been steamrolled doing so more times than I have enjoyed. Your opinion is not the only opinion..... nor is mine.
This board should continue to encourage varying opinions so we all can know the available choices or we lose any credibility, usefulness or effectiveness IMO

During my brief time on coumadin post surgery, I was up to about 100 mg per week and still climbing in dose. I don't care what anyone says about the right dose for each of us is the amount each of us needs to stay in our range, I hated taking that quantity. My personal experience was so distasteful to me I'd do most any reasonable thing to avoid ever taking coumadin again. That is only my story and no one else's but it comes from personal experience and not just theory.

 

[Marty]

This is an interesting thread. One facet to recognize is that doctors basically hate to manage warfarin dosage. It can be a real pain with occasional malpractise problems. They look forward to prescribing the "new' anticoagulants. My doctor loves it that I self test and self dose. I get one arm stick a year at my annual physical for him to to record.

 

[Protimenow]

Marty: I really appreciate your comments. I'm sure that we all (doctors included) would appreciate a new medication that you can take once daily (or maybe even once a week, if possible) that is easily tolerated and minimizes or reduces the risk of clotting that warfarin does. It would be great to not have to worry about bruising from overdosing or clots from underdosing - or to have to EVER test again.

You were lucky to find such an enlightened doctor. I wish that all doctors with patients on warfarin were as flexible as yours. (Of course, for patients incapable of self-testing or self-dosing, it would also be great to have easily accessed specialty clinics that can handle those tasks).

 

[Protimenow]

JKM7--I didn't mean to minimize or discount your bad experience with warfarin. I certainly wouldn't want to take 10 or more pills every day. You're apparently one of a small group of people whose bodies don't react to warfarin in the same way most of the population do.

I hope you can find a suitable alternative for anticoagulation management (and Pradaxa may be a good one) - but not taking ANY anticoagulant is extremely unsafe and risky.

I'm certainly interested in learning how this all works out for you.