November 18, 2010

Is There A New Coumadin Alternative Better Than Pradaxa?

Posted in Heart Disease in the News, New Heart Studies tagged , , , , , , , , at 2:28 am by keepyourhearthealthy

image by Salvatore Vuono

Pradaxa‘s manufacturer, Boehringer Ingelheim, had hoped to keep the cardiology buzz about their drug in the headlines this week.  Much to their chagrin, Bayer/Johnson & Johnson stole the spotlight with their new Coumadin alternative.

Over the past several days, the American Heart Association has been holding it’s Scientific Sessions for American cardiologists in Chicago.  The spotlight of cardiology news over the past month has been a new drug called Pradaxa (dabigatran).  Pradaxa is an alternative to Coumadin that was just approved by the FDA in October and is already available for special order at pharmacies in most states.  Patients with atrial fibrillation have been waiting 50 years for an option other than Coumadin in terms of stroke prevention.

On the Boehringer Ingelheim website, an article about Pradaxa had mentioned they would be presenting their large trial about Pradaxa at the American Heart Association’s Scientific Sessions in Chicago.  The news spotlight however has been stolen by a new, upcoming Coumadin alternative called Xareltorivaroxaban) which is manufactured by Bayer/Johnson & Johnson.  Xarelto has not yet been approved by the FDA but the phase 3 trials were presented at the Scientific Sessions, giving this potential new drug much more publicity than Pradaxa.  The big trial for Xarelto showed that it works just as well as Coumadin at preventing strokes in people with atrial fibrillation.  However, it will likely take at least a year before it is available as a prescription to patients.

So what is the big deal about this new Coumadin alternative called Xarelto?

  1. Xarelto only needs to be taken once a day whereas Pradaxa is twice a day
  2. Xarelto does not require fingerstick monitoring or dose adjustments (same as Pradaxa)
  3. Xarelto was tested in moderate to high risk patients and resulted in less problems with severe bleeding than Coumadin

Even though Xarelto sounds like a great option for patients who do not want to take Coumadin, we still have to look at the facts.  Right now, Pradaxa is the ONLY alternative to Coumadin that is available and FDA-approved.  Other drugs may be coming in the next few years but a better drug than Coumadin has been needed for more than 50 years!  The biggest problem with Pradaxa now is cost.  Out of pocket it is more than $6 per day and Medicare Part D is not covering it at this point. There’s no way to know when or IF Xarelto will be FDA-approved and how much it will cost.  Let’s just pray that we can work out the barriers of price soon so that everyone with atrial fibrillation can enjoy the benefits of stroke prevention without all the hassle of Coumadin.

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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!

October 4, 2010

Left Atrial Appendage Closure for Patients With Atrial Fibrillation

Posted in New Heart Studies, Uncategorized tagged , , , , , , , , at 3:26 pm by keepyourhearthealthy

Heart left atrial appendage transesophageal ec...

Image via Wikipedia

A new study testing a heart procedure could help prevent strokes in people with atrial fibrillation.

Atrial fibrillation is a very common and fairly benign abnormal heart rhythm.  It is caused by electrical disturbances in the upper chambers of the heart.  One of the biggest concerns related to atrial fibrillation is the possibility of stroke.  Because the upper heart chambers are not pumping effectively, blood has a tendency to “pool” into a small ear-shaped section of the heart called the left atrial appendage.  If blood sits in the left atrial appendage for too long, a clot is formed which can then travel to the brain and cause a stroke.

A new study has been testing the possibility of closing off the left atrial appendage as a means of preventing clot formation.  The device is called a Watchman occluder and it is put during a simple heart catheterization.  No large cuts or general anesthesia required!  Once the device is in place, a person could eventually stop taking Coumadin or warfarin.  The Watchman device cuts the risk of stroke without having to use medication.

The trials are ongoing so you can’t find this device in your general cardiologist’s office yet.  As the device is studied more and proven safe for everyone it may become available to the standard atrial fibrillation patient.  Between this and the new Coumadin alternative (dabagatran), we may be seeing the end of Coumadin once and for all!