tag:blogger.com,1999:blog-1350181109033523476.post375851232681407245..comments2023-08-24T00:28:08.108-07:00Comments on Why is American health care so expensive?: Is Pradaxa (dabigatran) dangerous? Comparing Pradaxa, Xarelto and warfarinJanice Boughtonhttp://www.blogger.com/profile/02321947802871503562noreply@blogger.comBlogger6125tag:blogger.com,1999:blog-1350181109033523476.post-40983360717548095192014-04-30T20:38:19.611-07:002014-04-30T20:38:19.611-07:00Good information, Janice Boughton. Thanks!
- PaulGood information, Janice Boughton. Thanks!<br />- PaulPaul J. Molinaro, M.D., J.D.http://www.888mdjdlaw.comnoreply@blogger.comtag:blogger.com,1999:blog-1350181109033523476.post-42871792325987221452014-04-27T19:49:53.943-07:002014-04-27T19:49:53.943-07:00All of these drugs are dangerous, but studies sugg...All of these drugs are dangerous, but studies suggest that the newer drugs, including pradaxa, are less likely to cause serious bleeding than warfarin. There is no reversal agent for pradaxa, but its half life is short, so unlike warfarin it gets out of the system on its own within a day. In practice, although warfarin can be reversed with vitamin K or fresh frozen plasma, it takes a long time, usually a day, to reverse its effects. It is always necessary to weigh the risks and benefits of the different options, including not using anticoagulants at all.Janice Boughtonhttps://www.blogger.com/profile/02321947802871503562noreply@blogger.comtag:blogger.com,1999:blog-1350181109033523476.post-50361816040049539712014-04-24T16:36:32.987-07:002014-04-24T16:36:32.987-07:00Cost is just one factor... safety is another...
O...Cost is just one factor... safety is another...<br /><br />One of the big “selling” points for Pradaxa as opposed to warfarin is that the patient taking Pradaxa does not have to submit himself or herself to regular blood draws and dietary restrictions. What promoters of Pradaxa conveniently do not tell physicians and patients is that there is no commonly available antidote for a Pradaxa overdose. Thus, should a patient’s Pradaxa levels reach a toxic level, he or she has a good chance of bleeding to death while physicians watch helplessly. Pradaxa levels are effected by advanced age, renal (kidney) function, extremes in body weight, and drug-drug interactions (aspirin, ibuprofen, nonsteroidal antiinflammatory drugs, and many other drugs commonly used by patients). In addition, should a patient on Pradaxa require emergency surgery (as a result of a motor vehicle accident, for example), he or she will be subject to uncontrolled bleeding and have a poor chance of successfully undergoing surgery. According to the National Center for Biotechnology Information, “In early 2013, there is still no routine coagulation test suitable for monitoring these patients; specific tests are only available in specialized laboratories. In early 2013 there is no antidote for dabigatran, rivaroxaban or apixaban, nor any specific treatment with proven efficacy for severe bleeding linked to these drugs. Recommendations on the management of bleeding in this setting are based mainly on pharmacological parameters and on scarce experimen-Haemodialysis reduces the plasma concentration of dabigatran, while rivaroxaban and apixaban cannot be eliminated by dialysis.”<br /><br />In the last few years, several thousand patients, who have suffered serious injuries including death, have sued Boehringer Ingelheim Pharmaceuticals, Inc., the manufacturer of Pradaxa for failing to warn patients and their physicians about the serious adverse events that may result from taking Pradaxa. Many of these suits also allege that Boehringer promoted Pradaxa as being safer than warfarin.<br /><br />If your physician has prescribed Pradaxa for you, you should immediately discuss whether there are safer alternative drugs for you. After weighing the risks and benefits, you and your physician can determine what drug is best for you. If you have taken Pradaxa, and have suffered uncontrollable bleeding, you should (after receiving medical treatment) consult with an attorney who is experienced in handling such a matter. <br /><br />- Paul <br /><br />Paul J. Molinaro, M.D., J.D. <br />Attorney at Law, PhysicianPaul J. Molinaro, M.D., J.D.http://www.888mdjdlaw.com/noreply@blogger.comtag:blogger.com,1999:blog-1350181109033523476.post-46582371258306346452012-04-20T07:41:09.684-07:002012-04-20T07:41:09.684-07:00I overheard nurses in the PCU talking about the co...I overheard nurses in the PCU talking about the cost of prothrombin complex. It goes under the brand names of Cofact, Octaplex and Beriplex, and I cannot find any info on its cost in the US. The nurses were saying something like $10,000, but that is hearsay. In England the cost is US equivalent of 75cents per unit and the dose is 50 units per kg which would be over $2000 for reversal dose. It's probably higher in the US.Janice Boughtonhttps://www.blogger.com/profile/02321947802871503562noreply@blogger.comtag:blogger.com,1999:blog-1350181109033523476.post-60344050831672139882012-03-01T22:57:48.773-08:002012-03-01T22:57:48.773-08:00Prothrombin complex immediately and completely rev...Prothrombin complex immediately and completely reverses the effects of xarelto (rivaroxaban) but doesn't work on pradaxa. (http://circ.ahajournals.org/content/early/2011/09/06/CIRCULATIONAHA.111.029017) The discontinuation issue has to do with the fact that when changing from Xarelto to warfarin we have to remember that it takes at least 3 days for warfarin to become effective, so the two should be overlapped.Janice Boughtonhttps://www.blogger.com/profile/02321947802871503562noreply@blogger.comtag:blogger.com,1999:blog-1350181109033523476.post-44516361563600161662012-03-01T20:56:56.732-08:002012-03-01T20:56:56.732-08:00The label for Xarelto states " no antidote &q...The label for Xarelto states " no antidote ", carries a black box warning for increased stroke when discontinuing and uncertainty if it is effective compared to well controlled warfarin since the rates were so low in the trial data. In the end it is good to have choice, but Pradaxa clearly has stronger outcomes data.Anonymousnoreply@blogger.com