What is the Best and Safest Anti-Coagulation Therapy? Here are the facts, you decide…

What is the Best and Safest Anti-Coagulation Therapy? Here are the facts, you decide…

  • 24 Feb 0

People with conditions such as Atrial Fibrillation, DVT, and Pulmonary Embolism, are required to take anti-coagulants to avoid suffering a debilitating stroke. Doctors often ponder what is the best regiment of anti-coagulation therapy to help keep my patients safe and out of the hospital. Here is the information you need to help you make an educated decision on the best anti-coagulation therapy for you!

With the new anti-coagulants that have hit the market, many physicians were quick to prescribe them to patients simply because they do not require any monitoring. Now with many patients taking the new anti-coagulants in real world conditions there have been thousands of serious internal bleeding episodes and thousands of deaths reported related to the new anticoagulants. This has spawned numerous lawsuits against the new anticoagulants.

A must read article from the New York Times describes the internal battle at Boehringer Ingelheim, the maker of Pradaxa, concerning the publication of a recent study done on Pradaxa. The new study brings to light that“The one-size-fits-all was a mistake for a drug with this kind of risk”. The issue has been hotly debated among heart and stroke specialists, in part because not all people, especially older patients, metabolize the drug the same way, and because there are no tests available for Pradaxa in order to monitor those who might be most at risk.

The anti-coagulation effects of Pradaxa, Xarelto, and Eliquis can NOT be measured by any sort of blood test, thus leaving patients subject to the manufacturers’ promise that this will work for them. The only way patients find out if the drug is not working as predicted is when they experience a bleeding event or suffer a stroke. Even more concerning is that there is NO antidote available for any of these drugs to reverse the anti-coagulating effects. Since there is no reversal agent the only solution is to give patients a blood transfusion or have them undergo dialysis.

With a lot of direct-to-consumer marketing of the new drugs via commercials, they only inform patients that it is a replacement for warfarin and that you don’t need to test your blood. What they don’t tell you is that is can be extremely dangerous not knowing how the drug is metabolizing in your body. In a recent article from the Legal Examiner, Dr Shezad Malik reviews Xarelto and the fact that it has been denied 3 times by the FDA for expanded use because of thedrug makers’ inability to show that the drug was both safe and effective.

All studies done on the new anti-coagulants compares their efficacy to patients on Coumadin testing once a month at the lab. However, studies reviewed by Medicare, in their decision to cover patient self testing, shows that patients self testing at home on a weekly basis as a preventative measure results in patients staying within their safe therapeutic range about 30% more often than with monthly lab tests. Thus if the studies on the new drugs were compared to people on Coumadin testing their INR at home the results would favor Coumadin every time.

This leads many to believe that the best and safest anti-coagulation therapy is Coumadin (warfarin) coupled with weekly INR tests. The anti-coagulating effects of Coumadin can be easily reversed with Vitamin K and a quick INR test from home lets you know instantly if you require more or less of the drug thus keeping you within your safe-therapeutic-range. 

“I am a firm believer in the people. If given the truth, they can be depended upon to meet any national crisis. The great point is to bring them the real facts.” – Abraham Lincoln

Links to more articles on the adverse affects of Pradaxa and Xarelto can be found on the Poison Review website.

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