There are two dangers that Afib patients face every day: the danger of blood clotting, and the danger of strokes. For the time being, the best way to prevent both of these conditions is through the use of blood thinners.
In 1954, the blood thinner Warfarin (also known under the popular brand name Coumadin) became an approved medication. Yet it was initially introduced as a pesticide that targeted rats and mice. It’s actually still used for this purpose every day. Nevertheless, it’s the most widely prescribed oral anticoagulant drug in North America.
With that being said, a new option called Pradaxa received FDA approval in 2010. This means that patients now have options, but which option should they choose?
Pradaxa Pros and Cons
Pradaxa offers at least one major benefit to patients: you don’t need to take regular blood tests. That means you spend less time and less money managing your condition.
In addition, it doesn’t interact as much with other drugs, or with your diet.
The RE-LY trial showed that Pradaxa had “a net clinical benefit compared with warfarin in patients with atrial fibrillation.” See Medpage Today and the “Tech-Savvy Anesthesia Resident” blog for more information on the tests. However, the studies also revealed some problems, and the people running the study were the same people who make Pradaxa. This isn’t necessarily a bad thing, nor does it indicate that they tampered with the study in any way. Still, it’s good to be aware of who is making what claims.
As it is, there are a few reasons to be concerned about using Pradaxa. The New York Times called Pradaxa “A Promising Drug with a Flaw.”
What is this major flaw? It’s the lack of an antidote. With Warfarin, there are ways to reverse its blood-thinning effects if it becomes necessary to do so. But Pradaxa has no such safeguard. If you experience excessive bleeding as a result of using Pradaxa, there’s a good chance you’ll die.
They New York Times articles reports:
Pradaxa has become a blockbuster drug in its two years on the market, bringing in more than $1 billion in sales for its maker, the privately held German drug maker Boehringer Ingelheim.
But Pradaxa has been linked to more than 500 deaths in the United States, and a chorus of complaints has risen from doctors, victims’ families and others in the medical community, who worry that the approval process was not sufficiently rigorous because it allowed a potentially dangerous drug to be sold without an option for reversing its effects.
…Critics say that at least until an antidote is found, better disclosure or more limited use of Pradaxa may be preferable. Patients’ lawyers have begun turning their attention to the drug. More than 100 lawsuits have been filed in federal courts and lawyers say thousands more are expected.
It’s really important to note that the people who are most at risk for suffering from excessive bleeding are elderly patients or those with kidney problems. Thus, if you fall into one of those two categories it might be best to steer clear of Pradaxa.
It’s also important to note that many patients on the RE-LY study quit using the drug because of other side effects like pain, vomiting, and diarrhea. At least one lawsuit cited internal gastrointestinal bleeding.
There has been one Pradaxa lawsuit filed after another in the past couple years. In fact, as of November 2013, there has been 1,800 lawsuits filed!
What About Coumadin/Warfarin?
Warfarin has a long track record of success. As long as you keep getting your regular blood tests it is generally very safe to use Warfarin. Warfarin has also been involved in numerous studies over the years which offer information about its safety and effectiveness in thinning blood and preventing strokes.
With that being said, every drug carries risks, even a “tried and true” option like Warfarin.
Warfarin works by interfering with your body’s ability to absorb and use Vitamin K. Since your body needs Vitamin K this puts you at risk for many other side effects, including bone fractures, dizziness, headaches, even skin necrosis.
And, of course, there is still a risk that you could die from excessive bleeding while taking Warfarin as well. The only difference between Pradaxa and Coumadin in this regard is the fact that Warfarin has an antidote and Pradaxa does not.
You also have to manage Warfarin very carefully. As mentioned earlier, it requires regular blood tests (for some patients “regular” means “weekly), which can be burdensome. You also have to control your food intake in ways that are sometimes unrealistic in a modern lifestyle. Warfarin patients are encouraged to eat exactly the same thing in the same quantities at the same time every day. Imagine trying to do that on a night when traffic is bad, when there’s a family emergency, or even on holidays when you’re trying to travel and celebrate with your family.
And, to keep your body safe and stable, you may have to restrict many of your activities because you have to avoid getting scratched or cut.
In fact, this is why Pradaxa was so popular when it hit the market. With Pradaxa, you just don’t have to worry about testing, or what you’re eating. That means you can enjoy a fuller, more active life with fewer restrictions and burdens.
Pradaxa vs Coumadin: So Which is Better?
In the end, this is a personal choice, based upon your own life circumstances, health, etc.
If you travel a lot and don’t have the time or inclination to eat the same thing every day, and you don’t have any of the higher risk conditions, then Pradaxa might be a good choice. However, it’s a much riskier bet for those with kidney problems, or those that are older.
Does that mean an otherwise healthy 50 year old with afib should feel 100% confident about Pradaxa? Not necessarily. It just means you’ve got a higher chance for success on the drug than a 70 year old with kidney problems.
If you feel nervous at all about the fact that Pradaxa doesn’t have an antidote then Warfarin is probably the better choice. Just be aware that it may make significant demands on your life.
You’ll have to talk to your doctor to weigh the risks and rewards of the drug for you. Unfortunately, every human is different and there’s no “one size fits all answer.” We all respond differently to the same drugs. What works for one person might be horrible for you.
I’m pretty fortunate. I don’t need to take blood thinners (yet) since I’m in the early stages of afib (I have occasional afib and only about one episode per year). However, if I ever did I would definitely start with Warfarin. If the constant testing and dieting restrictions weren’t working for me I would probably at least try taking Pradaxa. I would also look at some natural blood thinners like aspirin, fish oil supplements, and other such options (if those are even valid blood thinning options).
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