January 13, 2011

The New Coumadin Alternative…What Do Patients Think About It?

Posted in Heart disease tips, Helpful Heart Links, Uncategorized tagged , , , , , , , , , , at 11:47 am by keepyourhearthealthy

image by Idea go

Pradaxa is certainly ideal when you look at how it compares to Coumadin on paper.

Pradaxa is a breakthrough Coumadin alternative that prevents more strokes than Coumadin, does not require fingerstick monitoring and has almost no major interactions with food or other drugs. It sounds like a dream come true for atrial fibrillation patients everywhere who despise Coumadin!

Now that Pradaxa is readily available to patients, what do they think? Is it the amazing new drug that many have expected it to be?  Some say “yes” and some say “no.”  One Pradaxa user posted their experience with the drug on a Pacemaker Club website online and stated they “love the convenience.” Others on the same website complained that it did not work out for them.

The biggest obstacles for many are just what Pradaxa’s manufacturer expected: price and heartburn.  First, many people have to get over the sticker-shock of paying $40 to $250 per month.  Then there’s the common side effect of heartburn.  20% of patients discontinue Pradaxa because it upsets their stomach.

One patient I spoke to stopped it because the heartburn and nausea were intolerable after a few days of switching to Pradaxa.  She eventually switched back to Coumadin and resumed her routine INR checks.  In my opinion she was more likely to get heartburn on the Pradaxa because she also suffers from a large hiatal hernia (a condition where part of the stomach is squeezed up through the diaphragm) which causes problems with acid reflux.  Pradaxa’s manufacturer has already launched a defensive campaign in order to help patients work through problems related to the drug.  Their website www.pradaxa.com offers a support program which includes a hotline and a savings card.  I personally registered for the support program over 2 weeks ago and have yet to receive a response.  Maybe they have a few kinks to work out?

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January 4, 2011

American Heart Association Does Not Include New Coumadin Alternative in Updated Guidelines

Posted in Heart Disease in the News tagged , , , , , , , at 3:34 pm by keepyourhearthealthy

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Image by stevegarfield via Flickr

On December 20th the American Heart Association released the newest guidelines for management of atrial fibrillation…but something’s missing!

Despite the fact that American Heart Association president, Dr. Ralph Sacco, has called the new Coumadin alternatives “a great breakthrough,” the newest atrial fibrillation guidelines do not include the new anticoagulants.  Pradaxa was approved in October of 2010 and yet this guideline just released at the end of December does not guide US physicians on how to use it instead of Coumadin.  The American Heart Association reportedly states they will put out an “update” to the new guidelines at some point soon in order to include Pradaxa.  Until then, cardiologists will be relying on the manufacturer’s guidelines or recommendations from other physicians who are familiar with the drug.  It certainly presents for an interesting situation when the most updated guidelines are no help with the one of the biggest advancements in afib for over 50 years!

October 28, 2010

Canada Adds New Coumadin Alternative To Their Atrial Fibrillation Guidelines

Posted in Heart Disease in the News tagged , , , , , , , , , , , , at 1:47 am by keepyourhearthealthy

 

photo by Bill Longshaw

 

The newest anticoagulant drug Pradaxa (dabigatran) is already in Canada’s atrial fibrillation guidelines…even though it is still not approved to be sold in Canada!

Pradaxa (dabigatran) has made some huge headlines lately in the medical news ever since the FDA voted to approve it in September of this year.  Pradaxa is expected to be the first and only alternative to the super blood thinner Coumadin (warfarin).  For over 50 years people with atrial fibrillation have been forced to take Coumadin as a means of reducing their chances of stroke.  Coumadin requires frequent dose changes and blood checks to monitor the levels whereas Pradaxa does not.  (See previous article Coumadin and Warfarin Alternative Almost Here!)

In Canada, an update to their atrial fibrillation guidelines this week already includes recommendations for Pradaxa.  Surprisingly, Pradaxa is not even approved for market there yet!  It seems as though they have jumped the gun a bit but the authors are defending the update by saying it is “cutting edge.”  They apparently want to be prepared for the release of this promising new alternative drug.  Specifically, they recommend 150mg of Pradaxa to most patients in the future given that Pradaxa’s study showed this dose is more effective at preventing stroke than Coumadin.

The hype surrounding Pradaxa is certainly growing every day.  The manufacturer Boehringer Ingelheim has even started playing commercials here in the US.  Given that Pradaxa is not yet on pharmacy shelves, these commercials do not actually mention the drug name.  They simply offer to give more information about atrial fibrillation in general.  Since Boehringer Ingelheim is most well-known for its prostate drug Flomax, you can be certain the commercials are NOT a way to promote that medicine.  They are clearly gearing up their marketing for the highly anticipated Pradaxa.  And Canada is certainly rolling out the welcome mat!

September 2, 2010

New Alternative to Coumadin and Warfarin?

Posted in Heart disease tips, New Heart Studies tagged , , , , , , , , , , , , at 11:58 pm by keepyourhearthealthy

photo by Michal Marcol

Patients with atrial fibrillation know all too well the problems with Coumadin and warfarin.

Atrial fibrillation is a very common arrhythmia in which the top chambers of the heart beat quickly and erratically.  Since the pumping of the atria is abnormal during atrial fibrillation, a clot can form in the heart.  If the clot travels up to the brain this leads to a stroke.  For this reason, people with atrial fibrillation are at a higher risk of stroke and may need to take a strong blood thinner called Coumadin (generic name warfarin).

Coumadin and warfarin dosages are variable and need frequent monitoring.  One person may only need to take 5mg per day while another person might need 7.5mg per day.  Fingerstick checks are done every few days to every month for checking the level (called INR).  People who cannot or will not take Coumadin need to take at least an aspirin a day to lower the risk of stroke.  Sounds like a lot of work right?

A simpler drug may be available soon!  A new study out of Ontario has reviewed a new medicine called apixaban in terms of replacing Coumadin and warfarin.  When compared with aspirin only, apixaban reduced the risk of stroke and other clotting problems by 54%!  The dose is standard for everyone and apparently there is no need for fingerstick checks.  Let’s pray that apixaban makes it through the next trial so we can truly have a great new alternative to Coumadin!