Pradaxa vs Coumadin – Reducing Stroke Risk in Atrial Fibrillation

Is Pradaxa (dabigatran etexilate) better at reducing the risk for stroke than Coumadin (warfarin) in patients with atrial fibrillation?

Human heart

For many years, Coumadin has been the oral anticoagulant of choice as prophylaxis against thrombus formation in conditions like atrial fibrillation; however, drug interactions with antibiotics, psychiatric drugs, and other drug classes have made dosing and monitoring the extent of warfarin-based anticoagulation troublesome. Pradaxa, a direct thrombin inhibitor, is the first oral anticoagulant approved by the US Food and Drug Administration in over fifty years. This new drug eliminates the need for conventional “INR monitoring” and is associated with significantly fewer drug interactions and dietary restrictions compared to Coumadin.

In the RE-LY® trial, over 18,000 patients from 44 countries (all with a history of A-fib on EKG at screening or within six months before entering the trial) were assigned into three groups: 110 mg Pradaxa b.i.d, 150 mg Pradaxa b.i.d, and warfarin (adjusted for therapeutic INR between 2.0 and 3.0). The primary outcome was a systemic embolism or stroke. Follow-ups were done, on average, two years later.

Coumadin Pradaxa 110 mg Pradaxa 150 mg
Primary outcome 1.69% 1.53% 1.11%
Major bleeding 3.36% 2.71% 3.11%
Hemorrhagic stroke 0.38% 0.12% 0.10%
Mortality rate 4.13% 3.75% 3.64%

The results of this trial were strongly in Pradaxa’s favor. There were a reduction in the incidence of systemic emboli, stroke, major bleeding, and overall mortality in patients taking Pradaxa relative to those on Coumadin. The higher dose of Pradaxa (150 mg) was associated with a similar risk of major hemorrhage compared to Coumadin.1

In spite of the success, a larger percentage of participants on Pradaxa discontinued their enrollment in the trial because of gastrointestinal symptoms like pain, vomiting, and diarrhea. Pradaxa is better absorbed at a low pH, so the tablets contain a tartaric acid core which may have caused the GI irritation.

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Additional research is required to assess the long-term efficacy and safety for Pradaxa in other conditions where anticoagulation is indicated, but initial studies look promising in atrial fibrillation patients for prophylaxis against thrombotic events like strokes. With the United States’ healthcare system in a hotbed of fluctuation, the cost effectiveness of Pradaxa may be something to assess in more depth. Does the cost of warfarin (and necessary INR monitoring tests) make it more suitable for clinical use, or does the additional safety of Pradaxa justify its costs? This question and others will need to be further investigated as physicians learn more about the efficacy of Pradaxa in clinical practice.
1. “Dabigatran versus Warfarin in Patients with Atrial Fibrillation”      https://www.nejm.org/doi/full/10.1056/NEJMoa0905561

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Comments

  • Lauren

    We were just talking about this yesterday. Might want to take a look at some interesting studies on the cost effectiveness: http://www.annals.org/content/154/1/1.abstract

    • Dale

      Statistical studies of large samples are extremely useful, however, the art of medicine is the ability of the patient and physician understanding the details and applying their knowledge to the patient based on those details and how they relate to the needs and conditions of the patient. Read my earlier post on why I have quickly decided that Pradaxa is not for me. I will go over my decision process with my doc at our next visit and I am 99.9% certain that he will agree with my decision. Whenever you hear a TV news report on some drug, good or bad, just think “the devil is in the details” before jumping to any personal conclusions. And those details are best considered in consultation with your doctor.

      • Dale

        My 40 yr old son had his second ablation on Tuesday. Everything went well and he went back to work Friday. His cardiologist put him on Pradaxa for the first time on Wednesday. He is a police officer. Today (May 28, 2011) I received the following email from him that might be of interest to other Pradaxa users:

        “Dad,
        No nausea from the Pradaxa so far. Dr. xxxxxx’s strategy is taking a Prilosec with it and I guess that is doing the trick.

        I did have to leave work early yesterday to go back to Sequoia Hospital. Yesterday at about noon I was having peripheral vision issues and I’ve been coughing pretty bad. My periphery consisted of colors of the rainbows in squiggly “w” shapes. I was almost over a cold on the day of ablation but it came back in full force. Work took me off the beat, Dr. xxxxx had me do a chest x-ray and Opthamologist eval at 3 yesterday. Since the ablation this was the 2nd distortion of my peripheral vision.

        Nothing in the Opthamology report and just chest cold but nothing else came up on the xray. There are no other cases of distorted vision that he knows of but Dr. xxxxxxx’s RN is researching over the weekend. The Pradaxa has been the only change in diet and meds.” end of quoted email

        Early Friday he called and told me that he felt fantastic. The second ablation – the first was in March last year – was done because he suddenly experienced a couple of episodes of AFib in April after a year free. His doc explained after the second procedure that they found areas they had ablated a year ago which did not form scar tissue and those were likely the underlying cause of the new episodes of AFib that were coincident with him enjoying a couple of beers.

        I hope this info is of interest or helpful for other AFib sufferers. I would appreciate any relevant feedback from anyone with a similar experience with Pradaxa.

        • Dale

          Got an email from my son today regarding his latest visit with his cardiologist. Background: He had an ablation in March 2010 and a second one to “clean up a couple of spots” two weeks ago. His doc put him on Pradaxa instead of warfarin. He complained about distorted peripheral vision. Today, after a comprehensive ophthalmologist exam, hisccariologistold him he has had “post ablation ocular migraine.” Prognosis: Forget about it, they’ll go away. He hasn’t had any symptoms for the past three days.

          • Don

            I had the same problems with the migraines for a week after my ablation. I was told it was from the anesthesia

          • Dale

            Update on my son’s second ablation on May 24. All’s going well as scars form he is somewhat in and out of fibrillation but not debilitated in any way. He hasn’t missed any work-he’s a BART Transit cop in the SF Bay area – and is a very active Daddy enjoying their first child who is ten months old. His doc has said that his heart rhythm will probably stabilize in another month or so once the scars are all formed and the effects of the ablation are healed. He’s on Pradaxa with no discernible side effects. He’ll turn 41 in September and is abou6 6’6″ tall and about 235 lbs. Very athletic and fairly active.

          • Dale

            Update on my son: My son is a transit police officer. In early 2010 he was ablated with good success and his doctor put him on warfarin (coumadin). He underwent a “cleanup” ablation in May of 2011 and his doc switched him to a daily dose of Pradaxa. Yesterday I received a self photo he took in a men’s room mirror of himself with blood covering the area from between the mouth and nose down to where his uniform shirt covered his chest. He had an uncontrolled nosebleed. I was very alarmed as his anticoagulation status is obviously way too high. He is in a job where he might suffer a hit in the head or a severe cut at any time. I’ve urged him to discuss this with his doc at his scheduled appointment Wednesday next. It appears that the standard, and only approved, dose of Pradaxa is too much for a guy who is 6’6″ and 230lbs. I could not possibly avoid extreme anxiety of not knowing the degree of my anti-coagulation from day to day and month to month. I hope he will go back on warfarin where he had excellent success in staying within the INR 2.0-3.0 range. Myself, I find it rather easy to stay mostly within a range of 2.3-2.7 and seldom go out either high or low. If I drop down close to 2.0 I take a single extra 2.5mg dose and if I approach 3.0 I skip 2.5mg once. Next test I am always back near the center of the range. My normal total weekly dosage is 43mg. (4 x 7.5mg and 3 x 5.0mg)

          • Dale Herrington

            A “final” update on my son, a 41 year old police officer who had two ablations, the first in March 2010 and the second in May 2011. About a month ago he had a followup visit with his cardiologist who pronounced him “cured,” took him off Pradaxa, and told him to come back in a year for a brief followup. I was very worried about him being on Pradaxa because as a transit cop he does occasionally get into a physical scuffle and could easily experience a hit to the head. Luckily that never happened. If he had been on Coumadin with (probably) biweekly testing, I believe he would have been safer with an INR measured in the 2.5 range rather than Pradaxa where the degree of anticoagulation would be a mystery. I’m glad he’s off the stuff.

        • Renee

          Dale, to me it sounds like your son might have experienced either a TIA or a ocular migraine from his description of the vision problems. An ocular migraine is similar to a regular migraine, but the only thing experienced is a visual aura. I have had them. It is vascular in nature. One doctor described the phenomenon to me as a vascular spasm in the visual center of the brain. I got them before taking Pradaxa, but have had more frequent ones since starting.

          I also feel like Pradaxa affects my vision directly – photo sensitivity, blurred vision, double vision and dry eye – all that peak about two hours after each Pradaxa dose. My cardiologist doesn’t seem to believe me.

          The GI effects are the pits.

          Good luck.

          • Kathleen

            Renee. My cardiologist believed me. Have been on standard dose Pradaxa for over seven months. Eyes progressively worse, finally unable to drive at night. Diagnosed corneal stem cell sickness. Cause unknown. Stopped Pradaxa, in 24 hours eyes had stabilized for focus, light hypersensitivity better. Within 48 hours, eyes more stable and able to drive at night for the first time in a month. Renee, I feared blindness. I think there is something about this drug that is dangerous, simply because it can affect situations that are already going on, perhaps silently in the body. I still have healing to do to try to get my vision back to normal, but I am on the right path. Again, I am not saying Pradaxa caused the vision problem, but it clearly added some problems of it’s own. I wish you luck, Renee. Your comment pointed the way for me, and perhaps has saved my sight. Thank you, dear. Dr. Kathleen Levdar

        • Tom Mote, PhD

          You may have visual migraine. For many years I have had “squigley z shaped orange colored visual images” that begin very small and grow to fill my visual field over about a 15 minute period. They then disappear. My opthalmologist has diagnosed the condition as visual migraine. I take coumadine for AFib and the visual symptoms began many years before I was diagnosed with AFib.

          • Tom Mote, PhD

            Added info: For the past six years since my pacemaker, I have taken 10mg of Coumadine each day and had my blood tested every three or four weeks. Very rarely the dosage was slightly modified but it has averaged 10Mg. For most of those years the pacemaker was set for 60 PPM but a year ago it had to be replaced because of low battery voltage. The cardiologist raised the setting to about 80 PPM because I was throwing extra beats. I watched the monitor as he adjusted the pacemaker and it appeaared that there had been an extra pvp about half the time. When the rate was increased to 80 PPM the extra pulse disappeared and the cardiologist assured me that this would also increase the useful battery life by about an extra year or two. As I am now almost 87, perhaps I will not have to undergo a second replacement. . Dr. Tom Mote, Professor Emeritus, St. Marys University

    • Lola

      I have read most of these postings. I am quite upset that most of these people on coumadin believe they must cut out green leafy veggies ! That is not true! The rule is to eat an equal amount each day. Don’t go a week without and then eat a lot the next week. YOU NEED THEM IN YOUR BODY ! also the digital gadget in Drs office is not compatible with everyone ! Just found that out. Now going back to lab for blood draw . I was up and down like a yoyo. Very frustrated until the problem was discovered. EAT YOUR GREENS !

      • Maureen

        My mother in law was recently put on Coumadin she has completely stopped eating all green leafy vegetables! This is something she has always loved and eaton daily for lunch she is 83 years old. I am very worried about her health she losing weight and not eating right. Understandably she had a heart attack in March and was diagnosed with ling cancer at the time she has had the cancer removed completed radiation but is not eating. We would like her to eat healthy and are concerned about the Coumadin and all of the side effects. If someone could please let me know what they think about this drug and if their thoughts on Pradaxa it would be greatly appreciated! Thanks

        • Jeanne

          I have been on Warfarin or Coumadin for nearly 4 years now. I still eat leafy green vegetables. For me I was told do not change your diet very much once you are on a set eating plan they can adjust your dosage of Coumadin to suit the I.N.R. level to safe levels.
          The idea is not to gorge on green leafy veggies just to eat sensibly.

          I would advise getting in touch with a nutritionist to see about your Mom’s loss of weight problem. Good luck to you both.

      • Carolyn

        That is excellent advice. In fact, that was explained to us when my husband was put on Coumadin. I listened carefully because I do the cooking. His protine test was always within the range prescribed by his doctor and we eat greens regularly.

    • Guy

      Wow scary after reading quite a few post. Hope i can add my few cents and maybe help some. I was having 2-3 Afib average per month lasting 5-7 hrs per session remaining functional but dragging at half speed. One thing i noticed, my Afib were almost all on holidays and/or extreme excitement with a combo of alcohol mixed in -this combination would almost guarantee an Afib for me and sometime it would also be generated when i would cut the lawn extreme hot weather- sweating etc. (somtime)…Then on 2 Dec 2010, i went into an Afib, no obvious reason for this one and i could not convert within my usual time of 5-7 hrs, so after 24hrs of it, i turn myself in to the hospital where i stayed in for 4 days and finally i converted back to a normal rythm, came very close to have an oblation etc–Remedy was: dosage of SOTALOL (beta blocker) 120 MG TWICE A DAY! and since 4 Dec 2010 i have not had an AFIB…now when i get excited etc..sometimes, i will feel a short palpitation for 10 seconds or less and at first i would prepared myself for the usual Afib but so far it has not happen to this day and yes i tested it with a minimal of alcohol and full Christmas/ New Year worth of excitement. This has been the first time that i have not had a Afib in years. I was on coumadin therapy until that time but was switch to Pradaxa which has brought me here to your forum because i am seeing on tv– advertisement for lawsuit against Pradaxa. So far i am tolarating both medecine fairly well–the sotalol drove my pre hypertensive blood pressure down to below norm and heartbeat in the 50’s. My next move is to ask the Doc. about canceling the blood thinners. Hope this help someone.. Sleep aptena yes..sleep on your side if you cannot cope with the mask..it really help me. Have a good day, G

      • Dale Herrington

        One very well known “nickname” for AFib is “holiday heart.” What you described is classic – excitement, alcohol, celebrating. Almost a guaranteed trigger for AFib. I too have AFib and obstructive sleep apnea and tolerate my cpap mask without a problem. If my mom, who certainly did not have sleep apnea, hadn’t had lifelong AFib, I’d probably blame my AFib on the minor heart damage that occurred to my heart in the many years I now know I had sleep apnea but was undiagnosed. I’ve been on cpap nineteen years and my AFib was diagnosed twenty-one years ago. No further thickening of the atrial wall has occurred since then and I am healthy with no symptoms associated with any cardiac problems. I take Veralan, Digoxin, and Warfarin for anti-coag. One thing I notice contained in some comments onthis forum is that many people seem to think anti-coagulation protects you from stroke because you are in AFib. This is not the case. It is the moving in and out of AFib that can dislodge a clot that has developed due to AFib and send it along to the brain. Anyone with AFib, no matter how seldom it happens, is usually put on anti-coag therapy for life.

  • Jeanine

    Does anyone have information on how patients should be monitored prior to surgery since blood testing such as INR is not impacted? How can you tell if the risk of bleeding is still high?

    • claudette

      Have been on pradaxa 150 mg am and pm since Dec. 2010 Have had no problems at all except I still have the a-fib. My type is persistant, meaning apparently that I am not going to be rid of it. i was cardoverted before being put on Pradaxa. The a-fib returned after about 2 weeks and both the doc and i decided not to do it again because i would have to be on Coumadin/warfarin and i am very sensitive to it. My HNR goes way up. My doc tells me I am not going to have a heart attack, I can exercise as much as I want, I do drink beer with my sister when I visit her in CA. I have been to th ER once and have had Bacterial pneumonia 3 times since Dec 2010. Pulmonary function studies were good and we have decided that I am allergic to the propellants in the inhalers so I stopped using them. I take my Pradaxa and also Lopressor 200 mg daily a Prilosec daily. No blood tests necessary having no problems so far. I do need to exercise more and lose a little bit of weight. the doctor tested me for sleep apnea and said I have it but i do not use any kind of machine as I don’t agree with him.He also said sometimes when you have a sudden illness that a-fib can follow it. I don’t agree with tht either. I told him several times I was having palpitations and he ignored me. I believe i have had this condition for a long time and since 1998 I have taken 325mg of aspirin twice daily. i want to get back on that therapy and leave all this other mess alone but only if he agrees. I am in constant a-fib even with the Pradaxa. My blood clots faster than it did with Aspirin as I have cut myself and I don’t bleed a lot like you would think with someone on a blood thinner. I would bleed and bleed if I nicked myself when I was on Aspirin. I am going to try to convince the doc that Aspirin would be better for me than Pradaxa and much less expesive so we will see.

      • Dale Herrington

        ??? You are telling us that you are on a double-the-recommended and approved dose of Pradaxa. DANGEROUS! When you took aspirin as an anticoagulant, you took double or MORE of the recommended dose. You tell us that your Dr. diagnosed sleep apnea through a sleep study and you “disagree with him.” DANGEROUS! Why do you waste your time and money visiting doctors? Are you suicidal? Really, the text and context of your post indicates that you are not making “informed decisions” about your health care. Does your doctor know of all your “disagreements?” Does he know you are double dosing with Pradaxa?

      • Dale Herrington

        I should have added that the long term effects of obstuctive sleep apnea can CAUSE atrial fibrillation.

      • Sharon

        Your attitude towards a treatment plan is terrible. You are not willing to listen or conform to a plan and it will keep you in danger. At least get a second opinion so you can see your MD is on the right track. No wonder he is starting to ignore you. And you have a computer so use it. Do some reseach and you will see Aspirin will not help you with A-fib.

        • claudette

          The Dr knows ALL my medical history. HE put me on Aspirin 325mg twice daily. He put me on Pradaxa 150mg twice daily and Lopressor 200 mg daily. I’m not stupid and I am not self medicating. He even agree that Aspirin might be the way to go after being on pradaxa for a year. I have an upcoming appt. with him (my Cardiologist) in March.I will discuss it with him, as well as the sleep apnea machine. When I DO wear it, i usually find it in the floor when I wake up because apparently I sling it off in my sleep. When I took Aspirin I never had any problems, but a DR DID put me on that dose after a carotid artery surgery. I am just saying that IF I cut myself my blood clots faster than it did when I was only on Aspirin and if Pradaxa is a blood thinner, why does this happen? seems to me that being on Pradaxa I should bleed more freely than I do. I have told this to the Dr. and he seems to just dismiss it.

          • claudette

            I do conform to the regimen that my doctor put me on and yes, I DO USE MY COMPUTER AS A TOOL FOR RESEARCHINGTHIS MEDICATION. I didn’t say aspirin would help A-fib. He said with my type of A-fib (persistent) and all the other meds I am on, that it COULD. He is a Cardiologist and I have gotten a second opinion from another Cardiologist. There are three doctors that are monitoring me and I am hoping their lines of communicating with each other is very open. Maybe I should change doctors, because I KNOW I am on dangerous medication and TOO much of it. Thank you Dr. Sharon for your input, I appreciate it.

          • gerald robinson

            I am on cumidan 2.5 mg daily and take robaxacet for my bad back.Is this interfering with the cumidin?

      • Carolyn

        You may not have had a-fib when you had palpitations. I had palpitations diagnosed as mitral valve prolapse. Listen to your doctor unless you graduated from medical school at the top of your class.

  • http://rk.md Rishi

    We covered this exact paper in today’s morning report at St. Luke’s. It seems that, aside from the GI issues associated with Pradaxa, the inability to monitor the extent of a patient’s anticoagulation (like INR) may be a bad thing after all because of the unpredictable bleeding risks. Coupled with the fact that the drug has relatively little clinical adoption at the time being and is incredibly expensive compared to Coumadin, we’ll see where healthcare takes it.

  • Christine

    I have been on pradaxa and have had severe nausea that can last for hours. I am being switched to coumadin and hoping that I do well on that.

    • kathy melecio

      how long were you on pradaxa before the nausea?

  • jackie

    My husband had a serious incident on his warfarin. His spleen was bleeding
    internally and he was filling with fluid two trips to the er finally got a diagnosis of a bleeding spleen. he spent the next 7 days in icu and hospital getting his bleeding stopped and problems with his urinary tract, and a swollen prostrate. our cardioligist retired and we could not get into the doctor he recommended unil almost two months later and he was due for protime when this incident happened. these patients must be monitored more closely when there is a change of doctors. he could have bled to death and it was very scarey to him. no follow-up from the cardiology clinic he had been going too for over several months on how he was doing. my two cents worth for the incrediably volital drugs……

  • dan

    I have Afib. I was on coumadin for about a year. I had a major brain bleed, my coumadin level was supposed to be 1.4, but in the e.r. is was over 5, it had gone up in previous tests as high as 9. I had brain surgery (2 holes) in skull to get the blood out. I am now on pradaxa, and hoping this will be better.

    • jean marzella

      i had my aortic valve replaced. can i take praxada? i now take coumadin.

      • wendy

        Hi Jean, I’m a cardiac nurse. I work with one of the cardiologists that was a major enroller in the trial for Pradaxa. It is only FDA approved for non-valvular afib at the moment.

      • claudette

        If it was repaired you would not have to take anything, since it was replaced, you cannot take Pradaxa. This is what my cardiologist told me about my nephew who had a heart surgery on one of valves. Not sure which one. They only had to repair it so he only took Coumadin for a very short time and now takes nothing. But they told him no Pradaxa. I don’t like taking it because it is so new, and all meds have side effects and we don’t know all the side effects of this one. I’m no Dr. but I have been in Healthcare for 48 years so I DO know a few things.

  • Carolyn

    Can Pradaxa be taken in place of
    Coumadin with patients with heart valve replacements?

    • Rosanne

      I would sure like to know the answer to this. I have a mitral valve 40 years old and am having such a hard time being regulated, my INRs are to low.

    • Dawn

      I am a cardiac nurse that worked in a coumadin clinic for 12 years. Keep in mind both Coumadin and Pradaxa are blood thinners and can have side effects, just as any drug. Each person is unique and can have different issues with each of these meds. These posts are informative, but if you have questions or problems, many of these comments are not from medical professional. It would be best if you spoke to your doctor about your questions and concerns.

  • G Glenn

    How is it determined as to what strength of Pradaxa should be taken. Have been on Coumadin(Generic) since fall of 1996. With No test taken for clotting, how do you know that it is working? Am on a mail in drug plan that goes for a 90 day supply of perscriptions.
    The cost for a 90 day supply is? My Doctor is proving information that he has available. Am almost 82 years old. Have endured times being off Coumadin for surgeries. Will be checking my Drug plan for Co Pay,
    provide any information about that if you will. Thanks

    • Susan

      My doctor just subscribed the pradaxa at 150 mg 2 time a day.
      The cost after insurance was $95.07. The pharmist said it was over $200.00 before insurance. I am debating weather to take it. I am on cumodone and I don’t mind the check ups every month & my insurance cover all of it.

      • D

        recheck with your insurance now. Most insurances cover it now with a resonable copay ($30.00/month)

      • Guy

        While i was on coumadin, for some this notice may help you a great deal–thru my doctor he subcribed to a place where they delivered at my home a blood ck’ing device specically for coumadin level cks–very simple to use with a small prick to the finger..you call in your IN value etc.all in 5 minutes or less..and they report it to your doc. who in turn call you back if you need to take more or les coumadin.

        • claudette

          Yes, when I was on Coumadin, I obtained a tester and my docs absolutely would not give me my medicine. I kept telling him I knew how to do use it but the coag clinic doc said definitely no. So I sent it back and let the Cardiologist put me on Pradaxa. On Coumadin my INA kept going dangerously high. they started me out on a 5mg dose and my INR skyrocketed and they had a hard time getting it down to normal, and that could be the reason for refusing to let me check my own INR even though I am a nurse, retired but anyway so far I seem to be doing ok on Pradaxa

    • G Glenn

      My Drug Insurance has not approved Pradaxa.
      If emergency surgery is required, will bleeding be a problem if on Pradaxa?

      • G Glenn

        This quesion has never been answered as far as I can tell.

        • Melodie

          I’m told by my Dr. that in the case of emergency surgery there are things they can do. Including but not limited to transfusions.

        • elaine

          No!! There is NO antidote to Pradaxa. My brother-in-law (80 years old) was on 150mg. 2x a day, and developed a hematoma. The hospital had to wait till the stuff was out of his system (6 days) before they could do anything. Result: 1 small hole drilled, didn’t work, one craniotomy, followed by another craniotomy 4 days later, tonite he is in the ICU hoping this craniotomy will stop the bleeding. Do NOT take this stuff.

      • Dorothy Markle

        Yes. They have nothing to counteract the effects of Pradaxa at the present time. We just had a family member die from excessive, uncontrollable bleeding from a cracked pelvic bone. She had been on Pradaxa for only 40 days. Previous to the fall which cracked her pelvis she had been very, very tired. My husband is taking Pradaxa and is also VERY. VERY tired. I’m wondering if anyone else on Pradaxa has this problem. My husband is now very concerned about Pradaxa and is wanting off from it. If they have nothing to stop the bleeding if you should break a bone or need surgery, this is VERY scary.

        • Dale Herrington

          My wife is going on warfarin next week for a month in conjunction with a total knee replacement. In talking with our Anti-Coag Unit nurse supervisor, she commented that one doc she deals with will not prescribe or continue use of Pradaxa with any of his patients. The risk of severe/fatal bleeding if emergency surgery is needed is too high. They will send a nurse to our home twice a week for four weeks to make sure my wife’s INR does not go haywire.

          • elaine

            Her doctor has read his literature. Follow his directions. Warfarin can be reversed. Pradaxa can’t

        • D

          It is out of the system very quickly. You can see reversing of the medications as soon as 12 hours from last dose. This is a very similiar time frame you see when you give the antidote to a coumadin patient.

        • ralph responts

          on pradaxa 6 weeks previously on coumadin no change in other drugs or diet but exta tired can hardly function without nap. considering going back to coumadin to see if pradaxa the cause

        • Guy

          Me too, what I also noticed (been on pradaxa for 3 mos)and maybe it’s because of the tired feeling–that i do not want to do things that I would normally enjoy doing..Simple task such as mowing the lawn, now it seems to be a hassle.I think this med changes your mood-feelings.I am not as happy as i use to be–something is not right.
          I am coming up on a Dr visit and I am seriously thinking on going back to coumadin.
          As anybody else felt a change in their personality, productivity,feeling etc..??
          Please let me know.Thanks, Guy

          • Dale Herrington

            Today (3/26) I saw an ad from a “predatory” law firm inviting people to sue the maker of Pradaxa because serious side effects have been experienced by many users. The web site they reference claims over 200 people have died as a result of Pradaxa side effects. Although I take such exhortations from lawyers with an interest, the information is interesting and should/would be of interest to users and prospective users of Pradaxa. Here’s the link to the website:

            http://freeseandgoss.com/pradaxa/

          • Carolyn

            My husband gave up hunting this year after being on Pradaxa since last Jan. (10 months). He has no energy and seems depressed. His doctor’s nurse practitioner told him that tiredness was not a side affect of Pradaxa. I don’t believe her.

        • Gerry

          I had to have a Pacemaker inserted, I am on Pradaxa for 1 1/2 years. I had to go off the Pradaxa for only two days. I also had a large skin cancer removed without going off pradaxa at all. I have only had less than 30 minutes of a-fib since my Cardoversion over a year ago.I read where there have been more than 29,000 deaths from coumadin

        • Earl

          i had been on pradax for approx 1 yr and was very tired all the time, i went to my dr and asked him to put me back on warfarin, i am now feeling back to normal. maybe i’ll just take 325mg of aspirn per day, after doing some research, i think it is just as good as warfarin, with less bleed possibilities.

    • n

      You test on Coumadin because it is so unsecure and the INR changes all the time. With Pradaxa you don´t need a blood testing, because you don´t have interaction with nutrition or medication (seldom).
      With almost every other medication you don´t need test (Ibuprofen, ASS…). The INR is specific for coumadin, because it is not constant, like Pradaxa or all other drugs

      • elaine

        I have been on Coumadin over 20 years…only had one bleeding incident at the beginning. Eat right, eat the same amount of what you’re eating, moderation in all things.

    • D

      All the major mail order pharmacies have Pradaxa on their formulary and it costs about $7-$10/month. 150mg is the correct dose for everybody regardless of age or weight unless you have renal problems. If your creatinine clearance is between 15-30ml/min (indicative of severe renal disease) then the correct dose is 75mg.

      • Anna Russell

        I would really like to know where you can get Pradaxa for that low of a co-pay. I am on Medicare plus a supplemental Blue Cross/Blue Shield and also have Humana drug coverage. My co-pay for Pradaxa is $70 for 60 of the 150 mg capsules. Unfortunately, I will be at my “dough-nut hole” position in a couple of months because of other drugs I take. I notice that the amount my drug coverage carrier charges Medicare per prescription is about $240. It’s worth it if it keeps me from having a stroke, but I am wondering how long I can afford the $70 co-pay.

        • Twanda

          yes your blue/cross blue/sheild should pay I pay 30.00 for 150mg 60 capsules a month and I have blue/cross blue/sheild and pradaxa also have coupons call them they have a number that can help you also ask your doctor for a pradaxa co-pay card it helps out it pays all except 30.00 and it is good for 15 months

          • Twanda Campbell

            I just started pradaxa and one thing I have notice I do stay colder more and I bruise more so I have to be more careful

    • Guy

      for a month supply of pradaxa thru medicare and tricare for life is $ 14.00–i am 68 yrs old.

      • Dale Herrington

        Hi! Got your note about self testing. My wife was tested by a home health nurse with such a device after her knee replacement surgery. It never did give an accurate reading. I would give it a go except that I am retired and a trip over to our hospital lab once every four weeks is no inconvenience at all and the ten buck copay isn’t material to my finances. I’m keeping abreast of the situation and self testing might be in my future but not at the present time. I understand the device costs about $1200 and is not covered by my Medicare Advantage plan. But thanks for the insight!

        • elaine

          Medicare itself does cover this. I have had a meter for almost a year, and never gotten a bill for it.

  • http://rk.md Rishi

    To everyone inquiring about the details of Pradaxa’s dosing and indications, remember that I’m just a medical student and in no position to provide medical advice. As much as I appreciate the questions, they are far more appropriate for your physician to answer. :-)

  • Andrew

    By eating a yogurt and using the last spoon full of yogurt as the way of taking the pill, and not drinking any liquid for at least 20-30 minutes after taking the pill, the nausea is relieved completely or diminished greatly. The acids of the stomach and the acids of the pill are a hand full for the system to take all of a sudden. The yogurt coats the stomach when eaten in small scoops, allowing the yogurt to apply its coat to the stomach and making a bed for the pill to fall into with the last spoon full/ Give a try before going back to coumadin.

  • Sid

    Doc is considering switching me from Coumadin to Pradaxa as I am having a hard time adjusting doses of Coumadin. I take Pt test and feel uncomfortable that there are no test to check the effetiveness of Pradaxa. How do other people feel about that.

    • Dale

      Sid: Re INR being tough to control. Years ago I was involved in helping my very aging Mom in this respect. Here is what I found and some conclusions. Whenever she would go out of INR range, the attending nurse would change her dosage. A test a week or so later would show her back in range. But then the new dose might very well put her out of range in the other direction. We literally had to deal with swings constantly. I think the protocol is faulty and I control my own dosage differently. My dose has been fairly consistent for twenty years. My total dosage in a week is 45mg consisting of MWF at 5mg and the other four days at 7.5mg. If I somehow test out of range high or low I skip or add 2.5mg ONCE and retest in a week. I have never failed to come back into range after a week or ten days retest and stay in range. I resume my normal dose regimen at that point. I eat spinach (very rarely) and the same for grapefruit juice. I drink two or three beers or a couple of mixed drinks from time to time. I think the typical medical professional determining doses does not apply the nuances of dosing that I do. I should add if my INR even approaches 2.0 or 3.0, even if still barely in range, I also skip or add 2.5mg on a one time basis. I also should add that my blood volume is much higher than the typical AFib sufferer as I am 6’2″ and about 260 lbs. In summary, if I go out of range, I add or subtract 2.5mg ONCE out of a weekly dosage of 45mg and that has never failed to bring me back in range and, other than that 2.5mg variation in dosage, I return immediately to my “standard” dose. My standard dose has only change once in twenty years and that was an increase of 2.5mg per week about four years ago (determined by a several weeks pattern of tests and due to changing some dietary supplements). I hope this helps you to understand coumadin dosing. Please feel free to post any specific question if I have not clearly explained how I control my dosage. I do understand that this might not work for others whose INR jumps around due to physical conditions that I do not experience or interactions with medications.

      • judy devore

        hi…..thank you for sharing your dose-adjustment method….it mirrors the method used by my cardio nurse…..i’m writing because of your having taken coumadin for 20 years. I am 64 and have had afib for a couple of years. In trying to decide between coumadin and pradasa, I tend to favor coumadin only because pradaxa has not been around long enough show problems other than the gastic stuff. In deciding, I”ve wondered what, if any, are the risks of taking coumadin for decades…..since I hope to live to be 90 that means taking it for a long long time. I’ve read some stuff on line about the coumadin-induced Vitamin K deficiency having the effect of hardening the arteries!!! and of course putting folks at risk of a heart attack….also read that long term use can lead to greater risk of bleeding. Have you ever discussed any of this with your doc? info on this would really help me decide. thanks in advance. also, since i’m not sure how to use this site I’m on, perhaps you could email me at my own email which is [email protected] thanks again.

        • Dale

          I’ll shortly turn 72 (but look and feel 55 – excellent genes) and I’ve never heard of Vitamin K being a problem except that if you eat too much of it, it throws off your INR because it neutralizes warfarin. My heart is in great shape with no indication of any arterial blockages. I do eat salads and spinach as much as I like and my INR hardly ever varies outside a range of 2.3 to 2.8. Vitamin K is water soluble so anything that is heavy in it that is cooked can be just about eaten at will and in any quantity one wishes. Raw spinach might be a problem but a couple of months ago I ate three huge bowls of my wife’s spinach salad and my INR was in range at the next testing. I am fairly unique in that in twenty years I’ve only been out of range in either direction ONCE in excess of .10. In other words, if the standard were 1.9 to 3.1 instead of 2.0 to 3.0, I would only have a single out of range test (1.7) in twenty years. The one time I think I grabbed a digoxin one night instead of a coumadin. Five days later after one extra 5MG dose I was comfortably back over 2.0. I should emphasize that I thoroughly enjoy looking after my own INR and I do my own dosing at the rare time a brief change is needed. My anticoag service gets perfunctory agreement from me and I go my own way. It’s a bit like a game that I enjoy. Whenever I get tested I can’t wait for the phone call with the results. Can you spell “obsessive compulsive?” My son’s cardiologist put him on Pradaxa after his second, and hopefully final, ablation. He told him to take an antacid with the pill and he has had zero nausea. He’s 40 and physically active. He’s a police officer for BART in San Franciso.

          • Melodie

            Have you considered the home testing option? (Medicare now pays for this gizmo for people with chronic A-fib who are on Medicare)

          • Guy

            hi Dale, you may want to ck with your doc about the new gadget–something like the diebetics use–it ck’s you INR with a prick of the finger, anywhere, anytime, you feel you need to ck it–call it in –they call the doc or you can and off you go–5-10 minutes at the most..no pains and needles in the arm, do it yourself kit–cannot beat it..

        • D

          Pradaxa has been approved in Australia, Canada, and England for a few years. It has been in US for 1 year.

          • Howat

            Pradaxa –acccording to my specialist has only been approved/used in Canada for about 12 months you may be confusing the clinical trial time line with active/ approved use .
            I am a recent patient at one of Toronto’s 2 major heart centre’s . Their experience with Pradaxa is very worrisome particularly with recent bad bleeds and deaths of patients . Their anticoagulant specialists are intimately aware of the study supporting the the approval approval of Pradaxa .After a long and detailed discussion with these specialists about coumadin vs Pradaxa it was clear that coumadin was much safer and effective than the 12 month old Pradaxa .I have no difficulty maintaining the optimum INR so that also made my decision easier .
            The claim from the producers that Pradaxa reduces the risk of stroke by 35% is at least very questionable and can be very misleading .

          • Chris

            Pradaxa not approved in Australia yet, FYI

      • Dale

        Slight arithmetic correction. My total normal weekly dosage of warfarin is 43 mg, not 45. 3 days of 5 mg =15 plus 4 days of 7.5 mg = 28. 15 + 28 = 43.

        • Dale

          Whoops. Ignore that last one. somehow I forgot how to multiply 7.5 times four and came up with 28. Wrong. Total dose per week is 45mg.

    • Antonia

      I,m with you, I have been taking Coumadin for years ans so far so good, so I will not change medication.

      • Dale

        Those statistics favoring Pradaxa for a cohort of 18,000 patients might be worth using as a guideline for a doc if he had to prescribe for a couple of thousand patients without examining them or becoming familiar with their individual circumstances, ability to get tested regularly, ability to follow change of dose instructions etc. However, no cardiologist operates that way. But within that cohort of 18,000 I’ll bet there are hundreds, if not thousands whose INR is very stable from test to test; seldom goes out of range and then only by .05 or .10 and returns to in-range within a week and again is stable. That’s ME. Out of range six or eight times in nineteen years. Only ONCE more that .10 when my INR dropped suddenly to 1.7 (I think I took a digoxin one day in place of a 7.5 mg dose of Coumadin) and in that instance I was back well over 2.00 within a week and remained there for at least many months.
        Certainly the risk of a bleed is much higher in people whose INR goes frequently over 3.0, especially those who really get out of control and their INR goes above 4.0. I’d like to know the differences in risk between someone whose INR is between 2.1 and 2.9 for fifty of fifty two weeks each year, compared to what their risk would be if on Pradaxa.

        I once asked a cardio nurse at what point in a high INR reading would she consider the patient to be in imminent danger. As I recall, her answer was something like 3.7 would necessitate a rapid action to reduce INR such as skipping a couple of doses immediately and retesting in two or three days.
        In short, I feel no anxiety over any difference in risk between staying on warfarin and switching to Pradaxa.

        • D

          Doctors in america practice evidence based medicine. The reason docs are so in favor of Pradaxa is because the data comparing Pradaxa and coumadin is extremely reliable and clear. Bottom line is that it is a safer, more effective option.

          • Sharon

            Maybe I have missed something but I am wondering what your credentials are.

          • Howat

            Have you actually looked at the study ?There are issues with the study samples and statistical inferences .Ask someone who is intimately familiar with the 18,000 person study and the follow up evidence about Pradaxa You may change your views on it’s effectiveness and safety .
            The pet peeve of most specialists with coumadin is it’s management not it’s effectiveness .

      • Dale

        My INR today, June 29, is 2.8. It was 2.2 four weeks ago. Since my tendency is for my INR to rise slowly, I didn’t do any dosage adjustment four weeks ago. But I will skip a 2.5 mg portion of a dose this week because of the 2.8 reading. I’ll bet my next test is between 2.4 and 2.6.

        • Dale

          Tralah! And it was exactly 2.4 even though I missed a dose the Thursday night preceding the test (7.5mg) and made it up the next morning with only 5mg.

  • Dale

    I’ve been on warfarin for 20 years. In that time I’ve been briefly outside the 2.0 to 3.0 INR range about six times and always have gotten back into range within a few days, followed by months or years of remaining consistently in range. I’ve had perhaps two bruises in that twenty years and rare nosebleeds stop relatively easily. I’m 71 and obviously had AFib for many years before I was diagnosed in 1991. For me, remaining on Warfarin is a no-brainer. The miniscule (but statistically significant) advantages I do not believe would apply to me because I don’t suffer from the shortcomings of warfarin that many do. Maybe with more experience of people using Pradaxa it would become rational for me to switch, especially if one day I become less competent mentally to participate in my own care and decision making. I believe that day is far off in the future if at all. The monthly blood test does not inconvenience me nor do I have an aversion to blood draws as some do.

    • http://rk.md Rishi

      Thanks for your great insight, Dale!! We’ll have to continue watching how the medical community adopts Pradaxa… especially now that there are TV commercials. ;-)

      • Dale Herrington

        The intensity of the media advertising campaign makes me think that they aren’t getting the kind of enthusiastic response out of cardiologists that they had hoped for and are trying to stir up consumer demand in the form of patients hitting up their docs with “how about this new Pradaxa Doc. This monthly INR testing is a real inconvenience.”

    • Jack Fleck

      Dale,

      Thanks very much for your comment. I am 75 and had a cardioversion for my A-Fib in January. Other than the electrical problem, my heart is in very good shape (no enlargement, clogging problems, valve issues etc.). My doctor took me off Coumadin a couple of weeks ago, but I am uncomfortable not being on some kind of anticoagulant because my A-Fib could reoccur at any time and I might not be aware of it and possibly throw a clot. I’m not crazy about going on such a new drug like Pradaxa and prefer to stay with warfarin which has been around for decades. I’m heartened to read reports of people who have had long-term experience with it.

      • Dale

        Interestingly, our 40 yr old son underwent his second ablation (and probably last) just yesterday and his cardiologist is switching him to Pradaxa. I asked the doc about nausea and he said he always prescribes Prilosec or something similar for the first three weeks or so. He says the nausea usually goes away in a couple of weeks anyway. He also told me that in his practice/circle of cardiologist friends, they collectively have put several hundred patients on Pradaxa with very few problems. Still, it’s too new and my experience with warfarin is too trouble free for too long to made a sudden change.
        re our son (a police officer). His first ablation was successful but he recently had a couple of afib episodes and his doc decided to go in and see what’s what. He discovered a few places where, instead of the necessary scar tissue forming, the areas ablated had healed up without any scarring. He touched up those areas and expects son’s Afib to be a thing of the past from now on.

      • Dale

        My two year younger brother (now 69) underwent TWELVE cardioversions while in the Army between 1981 (first diagnosis) and 1990. He had his first ablation while it was still very experimental, then a second one about a year later. His atrial flutter was turned into atrial fibrillation. When afib hits him he has uncomfortable headaches so the Army gave him a pacemaker a couple of years before he retired in 1998. He’s now on his third pacemaker and while often in sinus rhythm, he still pops briefly into afib which the pacemaker immediately corrects. So he is on coumadin probably for life just like me. He was a runner until just recently when a knee acted up. A blessing in disguise as far as I am concerned because he is one of those people who subscribes to the “no pain, no gain” school and pushes himself way too hard so that he can pig out, drink wine and beer as desired, and still control his weight. He’s 6 foot even and trim at 200. When he gets over 210 he has had a tendency to embark on too much strenuous exercise which is what hurt his knee. He also has no trouble controlling his INR. While poorly controlled usage of coumadin creates risk of either bleeding or clotting, if properly controlled, my OPINION is that the risk of a blockage in the heart causing a heart attack is probably diminished somewhat. Our health care is so good and so sophisticated nowadays that a person with minor chronic problems who gets very regular medical attention probably has a better chance at a very long life than a person with no problems who ignores his health.

      • Dale

        Jack: Discuss with your doc. Maybe he will feel that a daily aspirin would provide a significant measure of protection without having to deal with regular monitoring. If your risk of a clot is minimal, there are enough bad things about coumadin in the direction of too much anticoagulation that your risk of a bad event might be higher using coumadin than not. Only your doc and you can evaluate and decide that.

        • Dale

          Update on my son, a police officer. He had his first ablation in early 2010 which was successful. But he had a brief relapse this past Spring and had a second “cleanup” ablation in May. This past Wednesday he had a cardio appt. His doc declared him “cured” and took him off Pradaxa and put him on a daily baby aspirin with an instruction to come back in a YEAR for a checkup. My boy will turn 41 in September – married for the first time in 2009, and now has a year old son and another child on the way. Our advanced medical science has taken his inherited cardiac difficulties and basically cured him for life. God bless our advanced medical community and the achievments they have made with serious conditions that were life threatening or life ending just a couple of decades ago.k

      • Michael Denham

        Jack Fleck. Were you in CAG 14 on the Oriskany??

    • Tom Mote, PhD

      I have taken Coumadin for more than six years and have endured the trips to the HMO for blood testing. My most recent results have been INR = 2.3 and 2.1 and within two days I receive a call from my GP telling me the results. He occasionaly makes a small change [never more than 5 or 10 MG] in the total weekly dose. I have spent the past hour reading the litany of Pradaxa vs Coumadin experiences and I have now decided to NOT ask my GP to consider switching me to Pradoxa. I have never had any nausia, skin rash, etc., resulting from Coumadin and the only problem, other than the periodic blood testing has been my dentist’s refusal to extract a tooth until I had been off Coumadin for a week or ten days. You should have heard my GP’s angry refusal to provide a letter to the dentist. Since I was in the middle, I had to sign a legal waiver before the extraction!

  • Minoue

    I have Factor5 leiden. Total trouble with warfarin, constant PT and INR test.
    Is this medicine good for factor 5 leiden patients???
    Thank you for your time!

    • Dale

      You might find this website useful:

      http://www.fvleiden.org/ask/

      • Minoue

        Thank you so much for the link!

    • D

      no! Pradaxa does not have an indication for patients with factor V clotting disorders.

  • G Glenn

    If on this Medication, and surgery is upcoming, is there another medication to void this medication for surgery or do you have to go thru a waiting time before surgery?

    • G Glenn

      Would appreciate an answer to the question about if surgery is required, what is done to void the drug
      that is being pushed to replace Coumadin

    • Dani

      Pradaxa is out of your system after a day. That is why it has to be taken twice a day. If you have an upcoming surgery the recommendation is to stop your Pradaxa 1-2 days before the procedure.

  • Nate

    To anyone considering Pradaxa, I would strongly encourage you to ask your prescribing Cardiologist what measures can be taken to reverse the drugs effect if you have an intracranial hemorrhage, a gastrointestinal hemorrhage, a severe nosebleed, are involved in an auto accident or other trauma or need any type of urgent or emergent surgery…the short answer is NONE. This medication may be lethal in any of these situations. 10% of pradaxa patients will have a GI bleed and 6% of those will be major. As an Emergency Physician I feel this is an extremely dangerous drug and potential patients should be fully aware of these risks and the 5-6x cost increase over coumadin/inr testing, prior to initiating therapy.

    • n

      Nate with Coumadin you can´t really do anything either in such accidents…. Vitamin K takes much to long to help…..
      The RE-LY Study showed -59% less intracranial hemorrhage and – 15% vascular mortality. But everyone should choose for themself. If you are happy on Coumadin or not open to a new drug, pospone it

    • Shirley Harbour

      Then what should people take who have been considering Pradaxa?

    • Jan

      I’ve been on warfarin for a few years, and have had to do PTINRs every week since my knee surgery in March. That’s added up to hundreds and hundreds of dollars. They have so much trouble getting my levels safe. Now I’m having knee replacement next week and am off the warfarin doing lovenox shots again. I’ve considered trying the pradaxa as our insurance charges the same regardless what we get. How is it any safer if you have any of these hemorrhages or bleeding on warfarin? I still bleed so much with the tiniest cut… Please give my your thoughts.

      • Sharon

        Jan, As I understand you have to get off Pradaxa when having surgery as well. I have an in-home INR monitoring kit and can get my INR whenever needed. Medicare pays for it and it has been a God-send for me as I live in a very rural area. So if I am on antibiotics or other meds that can interfere with my warfarin I can tell in a minute if dosage needs changed. The company notifies the doc and they call me. It is very accurate and is the same finger stick as diabetics do. As I have IBS and Gerd my doc feels Pradaxa is not the med for me.

      • Dani

        Unfortunately Pradaxa does not have an indication for your situation. It can currently only be used to reduce risk of stroke in patients that have afib.

    • Dani

      Your statistics are inaccurate. The risk of major GI bleeds was 1.6% compared to coumadin. The reversal mechanism in Pradaxa is its short half life of 12 hours (hence b.i.d. dosing) You will note that reversing coumadin by giving vitamin K has a similar time frame. Protocols for patients bleeding on Pradaxa are exactly the same as patients on Coumadin minus giving vitamin K.

  • Dianne Griffin

    My 83 yr old mother had ITP 5 years ago. She has a pacemaker and has A-fib. Her doctor has not put her on coumadin because of the IPT eventough her platelet count has been normal for the past 4 years. Would the same risks be associated with Pladaxa as with coumadin in her case? Obviously the Pladaxa would be helpful in reducing the risk of stroke.

  • Jenny Dalton

    I have been on Clexane injections 80mg twice daily for the last few years due to an alergic reaction to warfarin, I have an undiagnosed clotting disorder is Pradaxa suitable for a patient like me?

    • Dani

      It is not!

  • jenajena

    To all! I just took my first Pradaxa today. My history is I’m an a-fib person. But I stay in sinus while taking Solotol. i also was on warfarin. up to 7.5 day. Never could get above 1.4. Had stroke sept 2010. With still in
    sinus but had went off warfarin for dental. Even then my blood would never get above 2.0. I begged for blood work as I do remember having issues as little girl and while growing up many blood clots. They haven’t and won’t do the test i keep requesting, I also have major stomach issues. It’s like the doc’s don’t want to listen to me. If I begin bleeding inside, like the previous person stated, I’d like to also know what to do.
    When all of this started, April 2009, I went into afib. first time I’d ever heard of it. Hospitialized. cardiovirson. Sotolol and warfarin. sept 2010, stroke, mild but am fine now just a hearing different. still in sinus. and good bp, bpm’s. But INR’s never came back up. Before stroke and dental. INR’s 2.5. After and up to now and on, very sick at stomach for taking more and more bloodthinners. They have all this history, and still would not test for blooddisorders!
    I’m so frustrated, and angry that it’s a wonder any doc’s will care for me.
    They see every document, I always make sure I have the same as they do. Still if things are different, they go into overload on more meds for me. Oh and if I ask or advocate for myself, I am off to another doc.

  • Reid

    I was on coumadin and had two brain bleeds because coumadin is directly affected by pain medications and otherr Nsaids. I am concerned that this medication is not tested enough or, if in an emergency situation can the bleeding be reversed like it can witho coumadin.

  • G Glenn

    fI am missing something with reporting questions,- when do you answer them and where do I look for your answer,. thanks

    • G Glenn

      Again– if there is a need for emergency surgery,
      what is the procedure. Am away about Coumadin and can
      handle that, but why do you not tell an answer to my
      cuestion.

  • http://rk.md Rishi

    I’ve been getting several e-mails asking about the indications and side effects for Pradaxa. As I said in a previous comment, I am a MEDICAL STUDENT, not a licensed physician. Ask your doctor about details regarding this and all other medications. The original intent for this post was to summarize an article I had come across during my Internal Medicine rotation, but I’m glad people who have had experiences with this new drug are sharing their stories and offering advice. I myself am not in a position to provide any input, so please stop asking. :-)

    • Dale

      Thank you Rishi for running this great blog. If you ever have occasion to visit Sacramento and need a place to stay, you have one with us. “Half our neighborhood” is from India. Wonderful people and much better Americans than most people who were born here. I assume you were born in Texas but clearly your parents have passed along the “good genes” of hard work, diligence, and leading a responsible life to you. Keep it up!

      • http://rk.md Rishi

        Thank you so much for the kind words, Dale. Made my day! :-)

      • Ron

        Thanks for the great Blog Rishi. I just switched from Coumadin to Pradaxa today and all this info has helped me relax somewhat. My cardiologist seems to think Pradaxa is much superior to coumadin.

        • Melodie

          I switched just over a week ago. Pradaxa caused heartburns from hell and non-stop diarreah. I’m ready to switch back!
          How are you doing on the Pradaxa?

  • W. Wilson

    I have taken Coumadin for about 12 years for afib. I am 67 yrs old. Three months ago I went in for stress test and had 3 blockages at 99%. My wife and I were shocked because I was in the gym every day, ran a lot, lifted weights on a cardio program, mostly ate sensibly, and a very active guy. No symptoms prior to discovering the problem via mechanical stress test. I had very bad calcification in blood vessels. After some roto-rooter work with the drill cleaning out blood vessels I asked my cardio Dr about Pradaxa. He was all for it. Researching it I found in the medical journal “Blood” an article about a study that had been done involving rats (no humans yet) that had been on Coumadin. They discovered that Coumadin was causing in the rats, in a very short period of time, very heavy calcification of arteries. When they took the rats off Coumadin and started heavy doses of vitamin K-1, K-4, K-7, there was an amazing clearing of the arteries of calcification amounting to about 35% to 40%. That was in a very short period of time. There was no further follow-up study unless something is currently underway to see if this program of high dose Vitamin K-1, K-4, K-7, has provided further clearing of the arteries. Of course Coumadin users are not supposed to be eating anything with Vitamin K in it or to be taking supplementals containing Vitamin K. Two weeks ago I started taking Pradaxa and I have also started on a high doseage of Vitamin K-1, K-4, K-7 with a supplement pill. I also ate a grapefruit for the first time in many years and am also eating all the leafy green vegetables I want. I don’t know if this is going to reduce my calcified arteries but I am betting it will. Maybe not to the extent in the rat studies but hopefully as much. I have not noticed any side effects to the taking of the Pradaxa or of the heavily increased Vitamin K supplement. There are many supplements out there so best read up on it to make sure you get the right kind if you are inclined to take them.

    • Dale

      A little grapefruit or grapefruit juice now and then is meaningless to a regimen of coumadin or any other anti-coagulant. Spinach, the most often mentioned to patients on coumadin by medical personnel loses most of its Vitamin K when cooked. K is water soluble. My INR was 2.6 about twelve days ago. Shortly thereafter my wife made a great spinach salad and there was too much for everyone to eat. So Ihad three helpings in a weak moment. I will report my INR after my next test and I’ll bet it will be unaffected by my spinach orgy. Even if the raw spinach DID temporarily suppress my INR for a day or so, I doubt if it took it down to where there was any significantly increased risk of me suffering a stroke. I enjoy a small glass of fresh grapefruit juice whenever we have breakfast at Mimi’s as they include a glass of fruit juice with every breakfast. This happens about twice a year. No strokes have resulted from those deadly six ounce glasses of Vitamin K Killer.

      The only danger in eating a serving of spinach or drinking a glass of grapefruit juice is if one tends to allow that to begin a habit wherein one suddenly finds oneself ignoring the possible effects and eating/drinking according to one’s impulses while ignoring the warnings.

      • Dale

        My next inr was 2.8.

      • Dani

        This post is completely inaccurate! Coumadin has over 400 food interactions and they are deadly! You don’t have to avoid foods with vitamin K you just have to make sure your vitamin K levels are the same every day. If you have a grapefruit every morning then that is fine but you need to make sure you have it every morning. It is the fluxuations in vitamin k that are so dangerous. It isn’t just about you having a stroke, it is also about your risk of bleeding. These food interactions are just as likely to make your INR to high as it is to make your INR too low. You should not be presenting information that you obviously know nothing about. If you ate much more spinach that day than any other day, I guarantee your INR would have reflected it. Each time you do this you put yourself at serious risk! If you talk to and emergency room doc they will tell you that whenever they see a brain bleed on coumadin it is always accompanied by a high INR. I hope to god nobody considered your post reliable otherwise you put people at extreme risk of a life changing and potentially deadly episode!

      • Dani

        Also, if you ate a lot of vitamin K enriched food it will affect your INR within 24 hours…not a week later. I’m glad your INR went back to normal and you did not have an event but you did put yourself at incredible risk. As your doctor and they will confirm this.

    • judy devore

      hi….i’m trying to decide about changing from coumadin to pradaxa and came across something that talked about the Vitamin K deficiency resulting from long term coumadin use causing calcification of the arteries!! did your doctor say it was common? unusual? I’d love to know more about what you learned, if anything. I’m glad you’re doing better. I miss eating greens and I intuitively know that not eating them for years and years has to have a detrimental effect. Any info on this would be appreciated. thank you

      • shirley

        hi, I thought long and hard on whether to switch from coumadin to paradaxa and like you, I have really missed eating my green vegetables as well. My doctor said I was a good candidate for the switch to paradaxa. I was on coumidin 3.5 yrs. really grew tired of not being able to eat freely my vitamin k foods and also was tired of the testing. I started on pradaxa 8 days ago, so far so good, no side effects, it’s great to eat freely again, good luck with your decision.

        • Dale Herrington

          Re Vitamin K and leafy greens – First, K is water soluble so once spinach is cooked it can be fairly freely eaten as the V-K has been washed out of it. I eat leafy greens as much or as little as I desire. Once I even ate three large helpings of a spinach salad my wife made that was too much for the gathering it was prepared for. I saw no effect on my INR. Having said that, it is the consistency of diet that is important. You can’t eat no leafy greens for weeks with your coumadin dose adjusted to that diet and then eat raw spinach every day for a week. But anyone who says you must give up leafy greens if you are on coumadin is making an irresponsible recommedation. Moderation and consistency is everything. I eat a salad almost every day and my INR has been out of the 2.0 to 3.0 range perhaps ten times in twenty years..

    • Dani

      Coumadin will interact with any food that has vitamin K because it is a vitamin K antagonist. Pradaxa is not and has no food interactions. The mechanisms of these two drugs are completely different and very complicated. You can take vitamin K supplements and eat vitamin K rich foods with coumadin but you must ensure that your getting the same amount every day. It is the fluctuation in vitamin K levels that is the problem.

      • Sharon

        Do you work for the company that makes Pradaxa?

      • Charles Lee

        Tomorrow I will get my first Pradaxa. I have been on coumadin for a few months. I had afib and was cardioverted end of October and it seems to be holding. I see from this post that Pradaxa has no food interactions. That is great. How about having an alcoholic drink occasionally? I thank you for this blog.

        • Charles Lee

          I read this on another site.
          Alcohol

          Alcohol can interact with certain medicines.

          In the case of Pradaxa:

          there are no known interactions between alcohol and Pradaxa

        • Dale Herrington

          Can’t figure out how to post new on subject of afib anticoagulation so will put my thought here. I accept that as an afib sufferer, even on coumadin, I have a slightly elevated risk of stroke compared to non afib sufferers. But since aspirin is often suggested to aging people as a way to retard coagulation and prevent clot related heart attacks, I wonder if those of us being anti-coagulated enjoy some protection against myocardial infarction? Has this ever been studied? Comments anyone? Rishi?

    • Jason

      This is an iresponsible comment. There is no scientific evidence that coumadin causes calcificatio of the arteries.

      • Dale Herrington

        If your post was in response to mine about being on coumadin possibly providing some protection against mycardial infarction, nowhere in my post did I suggest coumadin causes or deals with “calcification” of arteries. My point was that being on coumadin, in addition to preventing strokes, also might provide some protection against a clot forming in and blocking a coronary artery that feeds the heart muscle with oxygenated blood.

  • Pete

    Dale: The squiggly “W” shapes, peripheral vision, and color stuff sounds like migraine aura, like “scintillating Scotoma”. Harmless if that is what it is.

    • Dale

      That was my “layman’s diagnosis” as well as that of his cardiologist. No repititions now for at least two weeks. He’s back to work unrestricted as a transit police officer. In fact, he returned to work on a Friday after his Tuesday ablation. No problems at all other than the what to him were mysterious vision anomalies.

      • Dale Herrington

        January of 2012 and my son continues his job as a police officer with no further symptoms of AFib since his second ablation in May of 2011. His cardiologist has pronounced him “cured” and told him to drop in in a year for a brief checkup.

  • Ron Fisher

    Started taking Pradaxa two weeks ago after going into A-Fib. When I had my last A-Fib episode two years ago I was on Cumadin for three months. I have had no major side effects from Pradaxa and enjoy not having to go in and get tested while watching what I eat. Winner drug for me so far.

  • Pat Townsend

    I had been taking warfarin after having A-Fib episode.Went to the lab for regular INR tests and they were fine. Then my Insurance and PCP changed. He was testing me by putting a small drop of blood on a digital read out in his office.The INR was always out of wack. He suggested Pradaxa. I have been on Pradaxa for 3 months. I have attacks of severe burning in my chest & esophagus. Dr. prescribed a medication that helps this gastro situation somewhat but not entirely. I want to return to warfarin. He states I cannot “keep changing” the meds. Suggests I need endoscopy. Tells me “sounds like ulcers” I said NO WAY. It is the PRADAXA!!! When I go to my Cardio guy I will BEG him to take me off Pradaxa…

    • Lola

      Balance vitamin K equally each day. Don’t leave out green leafy veggies ! Also that gadget in your Drs office may not be compatible to you! That was my problem. Had to go back to blood draw at the lab where that fact was discovered. Some people are not compatible with those small digital machines . Luckily it was found out ,but not until my dosages were like yoyos……up and down.

  • G Glenn

    Got this information June 23. Pradaxa is to be stored at 77 degrees, in its original package, away from heat, moisture, and light. If pills come in a bottle,it must be used in a 30 day period and if pills
    left at the end of the 30 days– throw them away. If on a 90 day supply per providers requirements, then
    you will have 60 pills to throw away and provider will not refill until near the 90 day time period of perscription. you can get blister packs in place of pills in a bottle Do not know about the pharmacy–they get multiple pills and count out from container
    to fill a perscription, so if they open the bottle,
    by this rule, then they would dispose of the ones that
    was in the bottle for 30 days. How does this grab you!! Is all of this true?????
    This information came from a well known Pharmacy.

    • http://rk.md Rishi

      Please ask your physician about details regarding Pradaxa.

    • Rene

      My husband is on Pradaxa now for 1 month after being on Coumadin for over a year. He has had NO problems at all on pradaxa and LOVES that he can now eat all the green leafy veges he wants. We have gotten Pradaxa at the local pharmacy & it came in the blister packs. We then got it through the mail order system & receiveda 9 month supply ALL in blister packs. There are just 2 things that you have to watch with Pradaxa. You have tomake sure it is temp regulated. It must be kept between 58 & 79 degrees. Also it can not moisture in it. Well, if you consider they come in a blister pack, it would be a little difficult to get it wet that way. Also, with regards to the temp regulation…if you are in an air conditioned home at 68-70 degrees during the summer & a heated homeat 70-72 degrees in the winter, that shouldn’t be a problem either.

    • Dani

      You won’t have to throw any away. When they send you a 90 day supply, they send you three bottles of 30. From the time you open a bottle, the capsules are stable for 60 days (this study is continuing to prove stability up to 90 days, although the label will not be changed until the study is complete and we know for sure the maximum number of days the capsules are stable after the bottle is opened). If you have Pradaxa in blister packs, none of this matters unless you pop all the capsules out of the blister pack. Basically the clock starts once the seal has been broken and the capsule is exposed to air. As a rule, keep all medicines in a cool dark place, Pradaxa included.

    • Dani

      You have to remember that pharmacies make significantly more money on generics than brands. For that reason they will always push generics. There is no generic for Pradaxa. What this pharmacy told you is not only inaccurate but it is completely unethical. The pharmacists should not be dispensing Pradaxa in a separate container (i.e. it should be in its orignal sealed bottle sent by the manufacturer.) Also, if a pharmacist works for a chain store they are incentivized and/penalized based on the amount of brand name drugs they dispense. Although this is an unethical practice, it comes down to profits. Some generics are just as good as the brand name drug but some are not. It is important to do your homework and ask your phycisian. Remember that Physicians #1 priority is taking care of patients and despite what is commonly thought, they receive NO kickbacks from Pharmceutical companies for prescribing specific drugs. This is an illegal practice and would result in the loss of their medical license.

    • Kim

      It now has a 4 month shelf life.

  • Pamelia

    My father is 74 years old presently and has been presented with the question by the electrophysiolgist regarding him switching to Pradaxa. HX: In FEB 2000 my father, age 63 then, underwent open heart surgery and had 4 vessels repaired. His surgery went very well as did his recovery. However he had one glich, when the surgical team restarted his heart so to speak his electrical conductive of his heart was off and thus he has had A-Fib since 2000. The MD’s put him on Betapace which contolled the A-Fib, and returned his heart to a sinus rhythum, but his dose had to be tritated to a high level. Prior to leaving the hospital his cardiologist tried serveral times to get my Dad to start Coumadim. However, my Dad is a dibetic (since 1989), and eats LOTS of green leaf vegs which would affect the coumadin levels as well as he not only worked a public job but then he ran the farm (200 acres and 65 head of Black Angus Cattle). So we did some research and discovered that taking coumadin was only 25% more effective than taking a 325 mg asprin daily. So he opted for the ASA and left the hospital. Then later in 2000 end of May-June my Dad began to feel tired (thought is was d/t my baby sister wedding) and began to have spells of dizziness. His B/P was fine however his HR was in the high 50’s low 60’s. (prior to the surgery my Dad’s HR was in the 60-70’s). One day while I was at work my Dad called and stated “I feel like I am on the Star Trek ship” maybe if I get up and walk around the house I’ll feel better. I told him to sit still and I would be right there. Left work and when I arrived his HR was 34 B/P was 120’s and he was co of feeling light headed. I took him to Duke and called his cardiologist office. They admitted him and observed him for a day or too and released him and stated that they couldn’t see any problems he was in sinus rhythum and no problems indicated. This happened 3 more times and with is 3rd occurance I called his cardiologist, afterhours and told him that I was bringing my Dad to the ER and that I was presently listening to his heart beat as 32 B/P was 102 sys sinus rhythum. We arrived at Duke, he was admitted observed and they were going to send him home again. I TOLD MY MOM NO THEY AREN’T SENDING HIM HOME HE NEEDS A PACMAKER DON’T YOU LET THEM SEND HIM HOME. MY Mom said I don’t know what to do…luck for her they were going to start him on Lovonex sq inj however since we live in a rual area and this was a fairly new drug, our pharmacy didn’t have the rx and wouldn’t have it until MON (this was on a Fri) So they agreed to keep him at Duke. Surprisingly, later that afternoon my Mom and Dad were watching TV and chatting when thru the door brusted 3 nurses and 2 md’s. They stated that my Dad’s heart had stopped for 52 sec and started back (as my Mom tells it they startled it back to working.). My Mom had been talkin at that point and never even realized and Dad himself stated afterwards that he again had begain to feel lightheaded and dizzy, yet he didn’t realize what was happening. So the cardiologist arrived and pronounced that they would be placing a pacemaker on MON am. (The nursing staff placed and taped the atropine right above his bed that they had prepared.)
    My Dad has had his pacemaker now 11 years with a min a-fib like 2 days within a 365 day period. However, the last 3 months his a-fib has increased to 8%. He was asked to start Pradaxa and is presently undecided. Your site gives lots for people to think about. Thanks for running this site.

  • Jan

    My mother has atrial fibrillation and recently visited a new cardiologist and put her on Pradaxa. She took the medication for nearly 3 months and passed away due to an intracerebral hemorrage. Was active and only health condition was hypertension which was controlled even during the hemorraghe she suffered. I strongly recommend for others to please review all medications and patient’s health prior to administrating this druge that proves to be lethal. In addition this drug requires no ability to monitor the extent of the patients anticoagulation and may be a bad thing because of the unpredictable bleeding it may enhance.

    • Dani

      Statistically, Pradaxa has 60% less risk of having a hemorrhagic stroke. I so sorry about your mother but people should know the facts. I know it is easy to criticize the “new guy in town” and given your experience you have every right to, but the fact is Coumadin’s rates and incidences of intracranial bleeds is astounding and frankly is higher than Pradaxa’s. Again, I am so sorry for your loss.

      • Agnes

        I read somewhere that nearly 300 people have died while on Pradaxa. Not very reassuring.

  • maynard

    At 400 bucks a month retail, 200 for us medicare folks in the donut hole, what makes pradaxa better than Coumadin? I understand it has slightly better stats, but wow! I have wpw ( ablated) now occasional a-fib which is completely controlled by 80mg of sotalol x2. (which is the same thing as the much cheaper lopressor?) In short in the corrected world, I dont have afib I dont have wpw, just a vvery slow heart rate,with controlled hbp. So what good is the somewhat safer, and somewhat better pradaxa doing for me? Now that said, after four months of the most embarassing urological tests you can devise, I still pass a fair amount of blood in the urine. My urologist, says to sit to pee and turn the light off. (he went on a bit along the same line) My IM says I am probably bleeding somewhere else also but dont know it. Other than that my arthritis is just killing me because they took away my nsaids, and I cant ride my bicycle, from fear of crashing. VP Dick Cheny had a line that said, “if there was a one percent chance of an attack the US should go all out to prevent it”, well he caught hell for having a hair trigger. In my medical case, my risk is far less than one percent, but here I am doped to the max.and am reduced to being an old man.(68) . However, I have to concede that the next five years are simply the most important in my life and I have the dough. But I would rather spend it on something somewhat sexyer Some thoughts please. I need some direction as to whom to chew out.

    • Dale

      My opinion based on logic and reading plus twenty years of safely taking coumadin – Not a medical pro, just an experienced user with a good brain. Here it is: Advantage of Pradaxa: No testing required. Disadvantage of Pradaxa: No testing required so you don’t really know exactly where you stand as to extent of anti-coagulation. Pradaxa probably a great advantage in cases where coumadin affected INR simply cannot be controlled or the user is incapable of following instructions as to regular dosage without skips or errors and money is not a major issue. Testing for some on coumadin is a major lifestyle disrupter; for others (like me) no big deal. The copay for Pradaxa (I’d never reach the donut hole) would bother me greatly as it would be over $100 for 90 days and my warfarin (coumadin)only costs me about $20 even if I don’t bother to put it on my insurance.
      My INR is in very tight control (it’s almost a game with me to keep it tighter than the protocol). I’m seldom outside a range of 2.3 to 2.7 whereas the protocol says 2.0 to 3.0. In fact, I’ve only been lower than 1.9 once in twenty years and never above 3.1. I’ve never had the nuances explained to me as to why Pradaxa is safe without any testing whatsoever. My own opinion is that I’d rather know exactly where my anticoag stands and only coumadin with testing every four weeks or so allows that. I should add that I’ve never had a nosebleed that was difficult to control, or any other bleeding for that matter, and I don’t bruise (two that I can recall in twenty years caused by hard raps).

      • judy d.

        i’m glad to hear that a long time coumadin user is doing well. i’m 64 and probably will be taking it the rest of my life and taking something this potent for so long scares me………other than the bleeding risk, which you have luckily avoided, I heard that the vitamin K deficiency created by the drug causes calcium to build up in the coronary arteries, ie. “hardening of the arteries”…………and that seems like the drug might reduce the risk of stroke but increase the risk of a heart attack…..do you know anything about this issue? re pradaxa….i too am concerned that the “no testing” means the doctor never knows how much effect the drug is having…………..your thoughts are most welcome.

        • Dani

          Coumadin is a very dangerous drug, there is no way around it! It is a necessary evil. Pradaxa isn’t risk free either but has significantly less serious risks than Coumadin and is better at reducing risk of stroke. See below replies explaining why you don’t have to get your INR tested.

    • judy d.

      hi…..read your post and am wondering why, if your a-fib is controlled with the solotol, are you having to take an anti-coagulant? i thought once the sinus rhythm was restored and maintained that the risk of stroke went back to “normal”. i’m not sure where your reply will end up……………do you? or does your response come to my regular email. I feel much lke you do about suddenly having to take a bunch of meds, and not being ablet to take an Advil for arthritis!!!,, and feeling quite “old” from the whole regime…………..as to who to chew out……………i’ve not a clue……………

      • maynard

        I am wondering as well. However after complaining I was put back on warfarin the arthritis is MUCH better. and the bleeding has stopped.

      • Dani

        Unfortunately your risk of stoke does not go back to normal. It is 5 times the “normal” person’s stroke risk regardless of the frequency of your afib episodes. Also, many people have afib episodes without realizing (there are not always obvious symptoms). You can take Advil with Pradaxa but there is a warning in the label that it may increase your risk of bleeds. I’m not sure but I think taking Advil with Coumadin is ill-advised.

    • Dani

      If you have no pharmacy benefits, Pradaxa costs $230 – $250 per month but if you have coverage the copays are usually around $30 per month. How do you know your risk is less than 1%? It is each person’s choice on which they want but it is important to have all the facts. Pradaxa is a dangerous drug too but I would take its risks over coumadin’s any day of the week.

    • Renee

      Maynard, I sympathize with your opinions. Anti-coagulation is full of more risks than what it is supposed to save us from if I read the statistics correctly. Not just the usually reported stats (inter cranial bleeds) but the ACCUMULATED stats of all risks – brain, cardiovascular, bleeds in general, retinal destruction, GI bleeds – the list goes on and on. Also, as you mentioned, the lifestyle dampers take their toll as well. For me, no more mountain hikes, kayaking and the latest recommendation from a doctor – no pool, as the risk of slipping on a wet surface is too great. The more I read, the more I’m convinced to talk my cardiologist into getting me off Pradaxa. My CHADS risk score is very low anyway.

      When I’ve asked in the past as to why I’m on it, the answer was “it’s standard protocol”.

      This is crazy . . . . .

    • Dale Herrington

      Simple! Go back to warfarin, assuming you can tightly control your INR as close to 2.5 as possible, even if you have to undergo the inconvenience of testing a bit more frequently than monthly. Then, if you fall off your bike and hit your head, you can go to the ER where I believe they can neutralize your warfarin to prevent intracranial bleeding – just in case. I suspect if Pradaxa were tested versus people who stay within 2.0 and 3.0 without fail, the stats favoring Pradaxa would not exist.

      If regular INR testing is difficult or impossible or you are afraid of a needle stick, you are stuck with Pradaxa. Otherwise, if you evaluate all factors, it looks like Pradaxa is bad for you, regardless of the cost penalty. I’ve been on warfarin for twenty two years without a blip. No bloody urine and only two unexplained bruises that I can recall (probably took a hit and didn’t notice). Nosebleeds (about two a year) stop within a minute or two of pressure. My INR has been out of the 2.0-3.0 range no more than a dozen times in 22 yrs and then only slightly and was back in range within a week when retested.

  • Walt

    Hearing more and more stories about patients using Pradxa falling on their head or getting a blow to the head and suffering a fatal brain hemmohrige. Scrary stuff. All I know is the more I learn about A-Fib and it’s treatment(s) the more anxious I become. When will this nightmare end?

    • Dani

      You’re hearing more about Pradaxa bad stories because it is new and heavily scrutinized. If you knew the bad stats on Coumadin you would be horrified! Coumadin has been a necessary evil for the past 50 years but it will be obsolete in a couple years now that there are other options.

  • judy d.

    hi…..i feel your pain………..the whole thing scares me too. but, as my cardiologist said when this whole mess started a couple years ago, “You’ll get used to it”…..and actually he was right. I’m confounded now by the coumadin-pradaxa choice, but the idea of having this arrhythmia (mine has become chronic after two temporarily successful cardioversions), is less scary that before. When did afib start? are you taking an anti-coagulant? what did doctor tell you?

    • Walt

      Hello Judy:

      My afib started end of march this year. I’m taking Pradaxa for 3 weeks and then will take Fecinaide in an attempt to chemical convert per the cardiologist at the Cleveland Clinic. And I’m requested to do this in a home setting! Cardiologist gives this chemical conversion 20-30% chance of succeeding? So I guess I’m starring down the barrells of doing a cardioversion if/when the aforemention fails. Hoping this works but based on what I’m reading here and elsewhere even if it works, Atrial Fibbrillation seems to always come back sooner or later.

      Walt

  • Sharon

    I am on Coumadin and do well on it. Not sure I want to switch to Pradaxa. I have an in-home test monitor from Philips and I test my INR every week. And if I go into A-fib I test it more often. This way I avoid ups and downs in my INR and can adjust the coumadin if needed.

  • Ann Schimmel

    Has anyone taking Pradaxa developed joint pin?

    • Maynard

      that would be me, my arthritis simply flared. Now back on warfarin and much happier, no bleeding no joint pain, just miday fatigue. Ah well.

  • Jeanne Godeau

    I have been on Warfarin now for nearly 2 years for my A.F. I do not find it a trial to have blood tests for clotting times. What no Dr has been able to confirm to me as to why when on Pradaxa they do not do occasional blood clotting tests. I have no intention in the near future to changing to it till I can get a decent and reassuring answer that I will not be at risk of throwing a clot or bleeding out.

    • judy d.

      i have exactly the same concern………..i’d like to give pradaxa a try but i won’t be doing it until i know how they know what’s going on with my blood once i take the recommended dose………….

    • Dani

      Pradaxa is not risk free (either is Coumadin) and there is never a guarantee that you won’t throw a clot or bleed on either drug. But that being said, the data is very clear that Pradaxa is a safer and more effective option (1/3 less chance of stroke compared to patients on Coumadin and significantly less serious bleeds on Pradaxa as well as better overall mortality rates). The only reason you have to do testing with Coumadin is because there are so many food and drug interactions that are constantly throwing coumadin out of whack. There is testing for Pradaxa but it is unnecessary. If you take it as instructed, there is nothing that interacts with it (except Rifampin), and you will be properly anticoagulated.

  • Jeanne Godeau

    Does anyone out there have an answer to the query as above.? Why no blood tests

  • Michael Denham

    Interesting comments. Saw my cardiologist on Weds. I asked about Pradaxa, and he said, it’s a good drug. “We will switch you over, but not until 30 days after September 12″ (when I am having a total knee replacement surgery). He said at that time, I should stop taking coumadin. When my INR falls below 2.0 (I figure that will take only 1 – 2 days), I should start on the Pradaxin. He didn’t mention any problems with Pradaxa, and that’s why I find this blog interesting !!

    • richard ducane

      Michael, I’m a patient now taking Pradaxa..I took Coumadin for about a year and had the usual side effects. I read a fair amount about Pradaxa. I thought the side effect would be less than Coumadin…WRONG…I have a bleeding problem, stomach pain and itching
      the same bruising as I had with Coumadin.I should have remembered “if it ain’t broke don’t fix it”. But the toughest lesson for me is this…If there is a side effect I’m going to have it, and less is more with me. Its a hard sell to tell a doctor the regular does might be to much for me i.e. Pradaxa 150mg twice a day..I still have an occasional dizzy spell or being light headed, which scares me about a fall etc…suggestion…keep reading, join an Afib support group if available….

      • Dani

        Remember, Pradaxa is an anticoagulant and is certainly not risk free but the data is very clear it is a safer and more effective option than Coumadin!

  • inneed

    oh wow, where did you buy your monitor we all want to know

    • Sharon

      I got my monitor from Phillips. But there are others out there to. Just google INR monitors. I called Phillips and they did the rest. Got the script from the MD and did the billing. I am on Medicare so they pay for most of it. There is a small co pay but well worth it. I live in a rural area and this is just great for me. I take my INR on Tuesdays. Call it in to Phillips on an 800 number. They have a range of normal from the doc. Mine is 2.0 to 3.0. I like it around 2.5. Then Phillips notifies the md and if its not within normal range the coumadin nurses call me and we talk about it. Any new meds, diet changes, etc. I check it right away if I go into A-fib so I know if I am protected. They send me the supplies when I need them. And when I first got the monitor they sent a nurse out to teach me how to use it. So easy. NO big ups and downs and if you do can be adjusted right away. I have checked this monitor twice with lab readings and it was right on. It is recommended to do weekly readings to keep you protected. Monthly are just not enough. There is a good site called a-fib.com and you can find all the latest facts and research on a-fib and the treatments.

  • inneed

    Hey thanks, I will look into it.

  • Vlad

    I am considering switching to Pradaxa but it seems with my replace aortic valve, it is not approved yet?
    I’ve had some close calls with Sintrom (very close to Coumadin) in the past where I had INR results of 5 and 9.
    I also have severe heartburn for the past 2 years, almost daily and Zantac seems to multiply the effect of the blood thinner.

    • Dani

      no indication for heart valve replacement yet. Studies are underway.

  • diane

    I was diagnosed with IHSS about 12 years ago. My cardiologist at that time put me on a beta blocker. In August of 2009, while at work, I suffered my first bout of A-fib. In Dec. 2009, I saw a rhythm specialist who recommended I have a pace maker implanted. In March 2010, I experienced my first “kick” from my pace maker because I was in a-fib again. Subsequently, I experienced that repeatedly. My cardio Docs put me on different types of beta blockers for months after. I suffered a stroke, which paralyzed my right side, in June 2010 when I spent a week in the ICU and 6 weeks in rehab. My heart is in A-fib more than 90% of the time. I was on coumadin from June 2010 until this past Monday, when I started on Pradaxa I have no side effects from this new drug and love the fact that I no longer have to go for blood draws and can eat the salads I enjoy so much.

    • judy d.

      what’s IHSS? you said you were on beta blockers when you had your stroke but were you on coumadin as well?

      • diane

        IHSS is Idiopathic Hypertrophic Subaortic Stenosis. My left ventricle is too thick, so my ventricles (bottom of the heart) pump harder to get the blood up to the top half of my heart. “Idiopathic” because they don’t know if it is hereditary or not. No one else in my family has it…and they do get checked.

      • diane

        No. I was not on coumadin then, not until after the stroke. I was on a 325 mg. aspirin prior to that.

  • http://la-vita.us/blog/ Lynn

    I’m new to this forum, and it has been very educational to read about others experiences with Coumadin and Pradaxa.

    During our stay in Mexico my husband was hospitalized and treated for massive blood clots in his legs, heart, and lungs. At first the doctor put him on Coumadin with regular testing.

    Friends told us about Alere, a company that sells home test kits for those on Coumadin. They have been with Alere for years and highly recommend them.

    As most of you know, for those that qualify for Medicare and with a doctor’s prescription, the home test kits and consumables are covered by Medicare. My husband was considering the InRatio2 home INR test kit. We’ve talked to them on the phone and they seem very flexible and reasonable to deal with.

    We have no financial connection in anyway to Alere, but for those considering a home test kit, here is their URL. http://www.alereinratio.com/

    About a month ago, the doctor switched him from Coumadin to Paradaxa 110mg. After six months on Paradaxa the doctor is planning to switch my husband’s medication from Paradaxa to one full aspirin a day.

    Recent CAT scans prove he is free of all blood clots.

    In addition to taking anticoagulant medication, my husband has a filter implanted in his inferior vena cava to prevent any possible future blood clots migrating from his legs to his heart and lungs.

    If you’d like to read my husband’s first person account of his battle with blood clots, you can find it here:
    http://la-vita.us/blog/2011/05/08/if-i-were-a-cat-id-have-7-lives/

    My husband is used to testing with Coumadin. He is concerned that no testing is required with Paradaxa. He would like to know if a test has been developed to monitor the effectiveness of Paradaxa? How are others addressing the no testing issue with Paradaxa?

    • Dani

      The only reason you have to do testing with Coumadin is because there are so many food and drug interactions that are constantly throwing coumadin out of whack. There is testing for Pradaxa but it is unnecessary. If you take it as instructed, there is nothing that interacts with it (except Rifampin), and you will be properly anticoagulated.

  • Jessica

    Hi, Does anyone know if this is just approved for pts where afib is their only reason for anticoagulation therapy? I’m asking because I was put on coumadin when I was 22. (I’m 28 now) I have clotting disorders, and have had a few PE’s, an MI, and a mini stroke. I’m currently taking 12.5mg monday, wednesday and friday, and 10mg the other days. My INR is still all over the place. (my range is 3.0-3.5) I also have Multifocal Atrial Tachycardia (with no underlying causes like COPD or anything) and have been ablated 2x and have had episodes of afib.
    Anyway, basically, I will need an anticoagulant for the rest of my life … I’m just wondering if anyone knows if this new drug will be a good substitute for the coumadin. Seems the doc’s aren’t sure about me being on coumadin for so long, what will happen to me. Doesn’t it eventually cause vascular issues? Like I said, I’ve been on it for 6 years already, and I’m only 28 … I have MANY years left to go!
    Thanks!

    • G Glenn

      Jessica- I have been on Coumadin for At Fib since the latter part of 1996.
      No one has said anything about being on it for so long. I see the Dr regularly. He has suggested Pradaxa but I have not said yes yet and it is not approved by my Drug Insurance Plan. Think in an emergency surgery needed, the MedicAl people can give a tranfusion of some sort to get into the clotting range arain.
      Am 82+ and have arthritis and from some comments in this program they report bleeding in the joints.Should I go pradaxa???– think I will wait and see more information from users.
      Medication– generally some can take x medicine and someone elst get on it and they cannot handle it. I got a high number on a clotting time
      years ago and the Dr said if that was a true number, I better not hit my head as I would die. In fact they called and had me sit in a chair.
      The high number eventually after testing two more times– was a problem in the Laboraty.

    • Dani

      Unfortunately Pradaxa is only approved to reduced risk of stroke in patients with atrial fibrillation. Studies are underway for other uses but not completed yet. Give it a year or two and there will be other indications.

      • Sharon

        I think you need to tell us why you know so much about Pradaxa because you may be saying things not all docs agree with.

  • The Daughter

    My 76 year old dad was taken off Warfarin/Cumadin that he took for 7 years with no problems, to try this new Pradaxa drug. Shortly after he suffered a SERIES OF MINI STROKES in July 2011. He was unable to talk/drooled, couldn’t hold a spoon, move his tongue. It is now October, and he has recovered. THEY HAVE PUT HIM BACK ON CUMADIN!!!!

  • G Glenn

    Hdave been on Coumadin (generic) since the latter part of 1996. have successfully gone thru surgeries and surgical procedures by stopping doseage a few days pror procedures. The Pradaxa drug– I want to see more
    case results before I think of switching.

  • fmajor

    Well it seems I missed a heated debate. Was away taking one urologic test after another, due to heavy amounts of blood in the urine after starting pradaxa. Bottom line nothing wrong, bleeding judged to be due to unknown causes. Back on Warfarin, bleeding stopped immediately. Feel great, INR easily controlled. I feel lucky to be alive. Oh, by the way Pardaxa is $400.00 a month. The cost threw me into the donut hole and will wind up costing me a huge amount of money, not counting my deductible and coin on the insurance. Overall I would estimate the testing for the brief trial to have cost over $50,000. Personally I dont think warfarin is any more dangerous than aspirin or effective. Pardaxa may have its place in an emergency situtation, but that is about it as far as this patient is concerned.I like my nurses and dont mind seeing them often, besides their office is next to a good starbucks. ;_).

  • Robyn L. Buckingham

    I had a severe reaction to coumadin because of raynauds (it caused my hair to fall out and I lost 2 fingernails while on coumadin therapy for lupus anticoagulant) I also had severe stomach cramps (it resulted in having to take bentyl to ease severe inflamation to my GI Tract, and loratab for pain related to pancreas, stomach, colon, and gal bladder inflamation) In addition to being coumadin resistant. My INR couldn’t be regulated, I was getting stuck 1-5 times a week (on average at least twice a week). the highest my INR ever was was a 6.9, just 2 days after it was a 1.8, two days later it was a 1.2, then four days later it was back up at a 5.2….this continued the entire time I was on coumadin So I’ve always taken lovenox as well. Coumadin made my periods irregular (spotting mostly, but also changed my cycle so it was unknown without ultrasound when we concieved our youngest son Jaydon) (we were not trying to get pregnant, but because of a history of cancer, nickel allergy, and a clotting disorder birth control is a toughie, so we use barrier methods) We didn’t discover the pregnancy until I was about 10 weeks, by which time coumadin did it’s damage. THANKFULLY he doesn’t have any major problems, but he was born with a cupped ear and an anal fistula (that became absessed with MRSA when he was 5 weeks old, but no further complecations have occured) It is unknown if he has any cardiovascular abnormalities, but he has presented no symptoms. I switched primarily to lovenox injections throughout the pregnancy and continued the injections after pregnancy to breastfeed. I will be starting pradaxa 23 October 2011 and would be happy to inform you of any side effects! I am hoping to have a much better experience with pradaxa than I did with coumadin, and it will be great to not look like a victim of abuse from the abdominal bruises from lovenox haha! My sister is a research scientist in the labs of Penn State (though I understand she is considering a position at a research lab in DC) so I understand how much information would be needed, and would really like to help with research and studies of anticoagulant therapy!

  • http://www.medaholic.com medaholic

    Wow, what an awesome thread. Just wanted to chime in my opinion as a 4th year medical student.

    I think Factor Xa (ie dabigatran) anticoagulation will be a promising new therapty for patients with A.Fib. At the moment there’s no immediate antidote for acute levels of dabigatran (I’ve seen a few overdose cases), but the convenience of not adjusting your meds and no need for routine blood work is a great benefit.

    I recommend that you also check out the recent ARISTOTLE trial on Apixaban (http://www.nejm.org/doi/full/10.1056/NEJMoa1107039) that shows a SUPERIORITY to coumadin.
    It’s the ever changing field of medicine that makes it such an interesting career for me!

    • Dale Herrington

      I can see where not testing can be a huge benefit and the non-requirement for testing implies that one’s level of anti-coagulation remains fairly constant. But I wonder if Pradaxa is really better/safer than warfarin for someone like me who has only been out of the recommended 2.0 to 3.0 range of INR fewer than a dozen times in twenty years? Monthly testing is neither a bother nor an inconvenience for me. I’m 72 and active but don’t do anything that might result in increased risk of a hit in the head but one never knows when something might fall off a building .

  • Dale Herrington

    Does my regimen of Coumadin possibly give me some extra protection against myocardial infarction? Aspirin is suggested by medical professionals to retard coagulation that could lead to a heart attack in aging individuals without afib. Have there been any studies on this subject. I would feel good if my slightly elevated risk of stroke were counteracted by a diminished risk of MCA. Comments anyone? Rishi?

    • Dale Herrington

      I’d like to add that in my opinion, any cardiologist who actively switches all or most of his patients to such a new drug as Pradaxa is failing in his duty to his patients by not considering the many situations that have come up in this blog. The “art” part of medicine is to fit the treatment to the individual patient.

      • Sharon

        I agree fully. My cardiologist is conservative and I appreciate that. I have IBS and GERD and he knows that Pradaxa would be a dangerous addition. Also I test my INR at home weekly and more if I go into A-fib so I always know if I am high enough when in a bout of it.

  • Sue

    I have spent an hour plus reading all these comments. I had emergency surgery in Sept., went into a-fib 2 days later (I was in sepsis) and put on comadin I am stll on it and was going to talk with my cardiologist about changing to pradaxa. I have RA and take Humira.I stopped that until all infection was gone. When my rhumatologist gave me a Tine test before re-starting the Humira, I tested positive..much to my surprise as this was a first! I am now on Rifampin so understand I am not a candidate for pradaxa at this time. I will continue to read this website as personal experiences are so helpful and provide good questions and good advice. Thank you! Dani…you seem so knowledgeable about these meds…are you a medical professional?

  • Jason

    I was on Pradaxa for one week as a result of A-fib cused by hyperthyroidism. I was given the radio-Iodine treatment, and hopefully the A-fib will stop when my throid is under control. In the meantime I found the side effects of Pradaxa so loathsome and disgusting that it was effecting the way I live. The Nausea was intolerable. I ntoiced from charts that given my age and other factors, my chance of getting a stroke, assuming the A-fib continues, is about 7% over the next 5 years. I’,m willingto take my chances and stop taking the stuff, with the added benefit of saving well over $200.00 per month. I’ll take 1000 mg of bufered aspirin each day. I don’t know if that will help, but I don’ care. One thing I do know, I won’t have to twist and turn in bed suffering from nausea and other side effects, nor will I suffer from sheer exhaustion or dying from an irreversible bleed.

  • al rivera

    Upon being admitted to the hospital, Doctors discovered I had Atrial Fib and they proceeded to performed cardiPversion on my heart. After the procedure I felt great,the doctor prescripted pradaxa. I took it for a year but my heart went back to AFib and I developed a blood clot on my heart. The doctor kept me on Pradaxa for a few more months to help my body eliminate the blood clot to my heart. The doctor tried four different times to do cardioversion to no avail due to the fact that the clot was still there. He decided to put me on coumadin, since pradaxa was not working on me. Apparently this medicine doesn’t work for everyone. My procedure is scheduled for the end of this month and I’m hoping the clot is gone and they can procceed with the cardioversion.

    • Dale Herrington

      Before you undergo another cardioversion I suggest you ask your cardiologist the following question: “Doctor, given that I have already reverted to A Fib after one cardioversion, in your experience what are the chances that a second cardioversion will be successful on a long term basis?” Only if you know the answer to this question can you make a truly informed decision if another cardioversion is appropriate for you. Personally, I have never heard of someone undergoing a second cardioversion after one that has, in effect, failed, then going into sinus rhythm and staying there long term. My brother, while in the Army, underwent TWELVE cardioversions over several years in an effort to get into sinus rhythm and off coumadin. Eventually he went through two ablations and now has had a pacemaker for about fifteen years. He’s just turned seventy and is healthy and vigorous albeit still on coumadin. His pacemaker rarely needs to intervene. I’m seventy two and have been on a regimen of Verapamil, coumadin, and digoxin for more than twenty years. I’ve never been cardioverted and am asymptomatic. Shows how different two cases can be, given that we are brothers. He was diagnosed at about age forty and I was diagnosed at fifty-two. The minimal treatment I have undergone over the years didn’t begin to work for him which is why he was cardioverted so often and underwent invasive procedures.

  • Jeanne

    Hi There: I have been on warfarin for nearly 2 years now. No problems at all. Were none of you told before starting this medication to keep to your old eating habits as much as possible and the dosage would be able to be handled in such a way to be beneficial to you. I eat green veggies, and other foods that I read some of you no longer consume. Maybe in New Zealand we do things a bit differently but in all my reading of Pradaxa and the side effects esp if you have digestive problems I would not personally take it. Having blood tests ease my mind and no one yet has convinced me that you do not need some kind of blood test to see what your clotting factors are while take it.

    • Dale Herrington

      Back in the ancient history of this subject I made the point that the statistic the producer of Pradaxa uses (35% lower risk of stroke) can be misleading. Certainly someone who can’t/won’t test regularly or for whom the test is very difficult might find Pradaxa to be a better anticoag solution than Warfarin. But for someone who doesn’t mind testing regularly and who never or almost never has his INR go out of range, I suspect Warfarin is a safer deal, both from the standpoint of effective, controlled anti-coagulation and the potential hazards related to Pradaxa if one suffers a severe hit in the head or an accident involving major bleeding. By the way, here in Sacramento we have been experiencing an unbelievably intense saturation advertising campaign for Pradaxa on television for at least the last year. It is not uncommon to see four or five commercial spots in a couple of hours of prime time TV watching.

  • Gerry

    I have spent the last two hours or more reading all the comments, I am 73 yrs old. In Jan 2011, went for routine Physical and found out I had A-fib.
    had been healthy all my life except for slight hypothyrodism. went to cardiologist, had cardioversion it worked but I had to take fleccinide to keep it in rhythm, I have always had a low pulse rate, never over 60, so the med made my pulse rate go down to 32-34, had to have a pacemaker, I have been on pradaxa for over a year, had gi side effects, not so bad to begin with but recently got worse, so I went for an egd scope and there was nothing at all, no ulcers no polyps, I had a hiatal hernia which I have had for years. so after a year on pradaxa no serious stomach problems.
    Since my cardioversion and the insertion of my pacemaker, I have not had more than 15 min of a-fib in a year. I am allergic to prilosec and all those stomach remedys so I take tagamet…it helps. I do get tired some days. I had to go off the pradaxa for 2 days before my scope…but I had a medium sized skin cancer cut out last week, did not have to stop pradaxa, my husband watched the
    Dr cut it out and he said there was very little blood. I cut my toe clipping my nails and it bled a little, I used the stuff men use when the cut themselves shaving and it stopped immediately. I have had no unusual bruising. after reading all the side effects of warfarin, I am happy to be on pradaxa. I think I have been on it longer than anyone on here.

  • amy

    I am currently a student in an ARNP/ENP program and about to undertake an integrated lit review project. It will take a lot of time, so I want an interesting topic. Pradaxa vs. coumadin treating a-fib is very interesting but I’m having a hard time finding supporting research. Could you give me any pointers? I do like your aspect of them preventing hemorrhagic stroke. Thank you!

    • Dale Herrington

      Most data on Pradaxa is from the manufacturer and formal clinical trials while there is a plethora of historical research on warfarin. If you simply believe the well constructed saturation ad campaign currently in progress for Pradaxa, no one would be continuing on warfarin. As a long time warfarin user (over twenty years) and having read everything I can find on Pradaxa, I predict that when the dust settles in about five years, warfarin will still be the anticoagulant drug of choice for most of us despite the inconvenience of monthly testing. Testing is a plus, too, because you almost never have to worry about where your level of anticoag status is. If you lead an active life and take a hit in the head or elsewhere, you’re far better off on warfarin. It’s so cheap it is practically free vs. a high price or copay with Pradaxa, always a consideration. On the other hand, for those who cannot control their INR with warfarin Pradaxa might be the regimen of choice.

      • Sharon

        I agree with you. First of all it is so important to check your INR weekly. Thats whay Medicare will pay for it that often. And more if needed. There are very few side effects. I use a home monitoring system and do random checks at a lab to check how accurate it is. Maybe every 6 weeks or so. If I go into A-fib I check it right away to know if I am protected. Education is the main thing.

        • Dale Herrington

          It’s a nice luxury to be able to check your INR on a weekly basis but the normal protocol is about once every four weeks or a month. So long as one has a history of relative stability, that should be frequent enough unless there is an out of range reading that needs prompt correction, in which case, a dosage change is made and a retest recommended in a week or ten days.

          • Sharon

            Its really not a luxury considering medicare and most insurance companies concur that weekly testing is needed and pay for the monitors and testing supplies. Especially for those who are in A-fib more frequently. I was recently put on steroids for severe asthma and was in a critical stage with the INR after one injection and one oral dose. If I had not had the ability to test frequently it could have been very dangerous. Patients need to know when to inform the cardiology office of new meds that may be ordered by other doctors or any new illness that comes along. After two days and a hold on coumadin and a retest my INR was still very high. My doctor orders INR testing weekly and as needed and I am sure glad he does.

  • Dale Herrington

    Of course one can get tested, and insurance will pay for it, more frequently than once a month but the vast majority of people on warfarin test monthly unless there is a problem. You seem to harbor a misconception that anti-coagulation is carried out as a treatment that is gauged to incidents of going into AFib. It is not some sort of preventive against Afib. It is to prevent a clot forming in the heart and dislodging and heading for the brain. Numerous incidents of going into AFib or long periods staying out of AFib do not affect the dosage or frequency of anti-coag treatment. As I understand it, it is the going in and out of AFib that creates the danger of stroke so even if you are in sinus rhythm for weeks at a time, if you have a tendency to slip into AFib then anticoag therapy is indicated. Anticoag therapy is not an incidental treatment for incidents of AFib. That is, it is not prescribed as some sort of antidote to instances of AFib.

    Weekly testing is NOT the norm for 99% of AFib patients on warfarin. Monthly is. But insurers will pay for testing as freqently as needed to keep one’s INR between 2.0 and 3.0. Weekly testing is only for people whose INR jumps around seemingly uncontrollably. I believe anyone who reqires weekly testing over long periods of time would probably be better off with Pradaxa. I am not a physician but a twenty year plus AFib patient always on warfarin as a stroke preventive.

    From your description of your changing meds and conditions of health, it certainly sounds reasonable that your doc would order more frequent testing, at least until your INR can be stabilized on a level dosage.

    • Sharon

      You are misunderstanding what I am saying regarding the importance of being in a therapeutic range. I have persistant A-fib. I stay home unless the A-fib goes on longer than is safe. I double dose on my Cardizem and usually I convert within 10 hours. The first thing I do when I go into A-fib is check my INR. The first thing the MD asks when I call him is “what is your INR today”. Does no good to be on Coumadin for years and then when you need it most you are in a low reading. Because I am on other meds which can interfer and have medical conditions which make it difficult I must check weekly. I am usually in range. I am now going to be put on antiarrythmics after a stay in hospital to check for reactions. If that goes well I will stay on them until they are no longer effective. Then its to ablation. Europe has taken antiarrythymics out of the protocol and go straight to ablation. However if I can get 4-5 years out of this there may be most successful things that come along by that time. I cannot be put on Pradaxa due to severe IBS and diverticulitis which would make it too dangerous. I know coumadin is not a treatment for A-fib but it certainly keeps the risk for stroke down 40-60%. Many cardiologists now are agreeing with weekly INRs. I have three friends with it and two of them do weekly testing .And if I can buy more time on meds I have a better chance of getting a better surgical intervention in the end.

  • Judy Spock

    On Coumadin my husband and I were warned to avoid the crucifers: cabbage, broccoli, chard, and also grapefruit. Does Pradaxa have these warnings as well? Other ones? What are they?

    • Paula

      With no know antidote to the effects of Pradaxa, bleed-outs can happen so quickly that death occurs before measures can be taken to prevent it. There is no known method for measuring the anticoagulant effect of Pradaxa. 260 deaths worldwide have been definitively linked to Pradaxa!!!!!!
      http://www.afibbers.org is a very informative website for those interested in taking an active role in the care of their AFib.

  • Dale Herrington

    An update on my opinion of Pradaxa (and everyone is entitled to my opinion GG) – The saturation advertising makes me think the docs aren’t taking to Pradaxa as rapidly as hoped for by the manufacturer. They are trying to stimulate people to bug their doctors to try it. And of course, busy docs are often too preoccupied to argue so they write the prescription. I’m also seeing ads from plaintiff law firms telling the public about deaths from Pradaxa and class action lawsuits in progress. Of course plaintiff lawyers often sue over nothing but trumped up evidence but this still gives me pause on Pradaxa. I still hold the opinion that is is only advantageous for those who cannot tolerate warfarin for one reason or another. The stats from testing that seem to show a significant advantage for Pradaxa over warfarin are meaningless without knowing the “internals” of the testing, i.e. how Pradaxa stacks up against warfarin for the many sub-groups that can be isolated from the 18,000 participants based on age, ability to follow dosage instructions, stability of reaction to warfarin, ability to be regularly tested, and predictability of the effect of small dosage changes. If we, the public, had access to those internals, I’ll bet for some subgroups Pradaxa is a miracle drug and for others a much worse choice than warfarin.

  • Mary Elsen

    I just discovered this website and I found it very helpful in making a decision re Coumadin vs. Pradaxa. My only critcism might be I wish dates would also reflect the years…especially since Pradaxa is (for me) relatively new.

  • Don

    Well, having reviewed many of the posts I do have something to add. I have had A-Fib for many years. I have had 3 abulations and finally had a pacemaker in stalled, which has been great. Of course I have been on warfarin most of that time with no problems . About a year ago after the pacemaker was in the doctor talked me into Prodaxa. Sounded great, and went ok. I went in for a simple bladder check. Stopped Prodaxa three days before, doctor took a biopsy etc. so far every thing was ok. One day later I was clear, I took first 150 mg Prodaxa, within one hour I was showing pink urine, one hour latter bright red blood . Went my doctor and he flushed alote of blood out, he put in a cath., and sent me home. On a Friday at 1:30am I went to the ER. There the ER doctor put in the biggest cath., they had too try too pass blood clots. (the ER doctor told me they did not know how to reverse Prodaxa bleeding.) I was in the hospital 5 days, passing blood the whole time. My hemoglobin went from 14 to 9, which is low. They tried frozen plasma to help clots, did not work. Plasma will reverse warfarin . After 6 days the bleeding stopped. This was just a simple test I had. THE PROBLEM IS THEY DO NOT KNOW HOW TO REVERSE THE BLEEDING FROM PRODAXA, Ask your doctor, he may say, well, it’s out oo your system in 12 hours, don’t think so…

    • dale herrington

      I am convinced, based on all the anecdotal evidence on this site over the past two years; other public information on the dangers and shortcomings of Pradaxa; and my own knowledge of controlling INR with coumadin, that Pradaxa will soon become a major media concern and its usage will wind up limited to those few people (mostly very elderly) who simply cannot deal with coumadin because of frequent testing and having to vary dosage according to test results. I’m sure the makers of Pradaxa figured they could tap into this huge market and dominate it with their very expensive drug, based on regular testing being considered a major nuisance for many coumadin users. One thing I can guarantee is that if everyone simply had to pay for their drugs, Pradaxa would 1) never have been developed and 2) if it had, hardly anyone would buy it. The culprit here is third party payment where the user has no interest in actually saving money or evaluating his/her treatment based on cost effectiveness.

    • Jeanne

      We have to take some responsibility for what medications we consume. My first query to my Dr was why no I.N.R. testing if you are on Pradaxa. this question my Dr put to the panel that he attended later that week and got no reassuring reply. Some of this posts re Pradaxa v Warfarin are mind boggling. I have been on Warfarin for 3 years now with no side effects at all. I do not find the I.N.R. tests that painful and at least with Warfarin there is a treatment if your clotting takes too long. AS for changes to diet I do so slowly and still manage to eat most of what I consumed before having to take Warfarin for my A.F. Maybe the Food and Drug administration people need to take a closer look at Pradaxa and ask why this drug has been used when there is clearly some monitoring that still needs to be assessed. I will stick to old faithful Warfarin. Cheers

  • Debby M

    I am very new to afib, having had my first episode last week. Spent 6 hours in the ER while they worked to get my heart down from 150. I was admitted to the hospital as, although the rate was down below 70, I was still not in sinus rhythm. Overnight my heart converted to normal rhythm w/drug therapy. 3 cardiologist who saw me during my stay all recommended Prodaxa and I was sent home with prescription for it after taking it in the hospital and being monitored for the first 18 hours. Now I am reading about problems and concerns with it and wondering if I shouldn’t.

    • Guy

      Hi Deb M. ,
      This is Guy replying , i have AFib for many years, the onset of Afib can be very scary and i will give you my experience as best as i can..
      At thia time now, I am on Sotalol 120 mg twice a day–and a baby asperin per day as suggested my very well renowned cardialogist here in Miami…
      Prior to this , i was on pradaxa and sotalol..like most folks i was wary of pradaxa and it’s effects..before that –i was on coumadin etc..
      one day i was in a serious AFib condition whereupon i could not convert back to a regular rythm as i would normally do within 6-8 hrs–so for 4 days they tried to get me back to a norm and finally they did before they were going to attemtp to do the eletricfing ..anyway while they were adjusting the proper dose of sotalol i reverted back to a norm–thanks to the sotalol!..it’s been a year now i had very short afib twice ..unbelievable when i was doing at least 3-4 a month–very stressing for about 8 hrs a stretch…so please talk to your cardioligist about this med –sotalol it may help you a lot—the major effect is i gained about 10-15 lbs and hard to get rid of!..i am 69 now and really feeling good and going thru Isaac the tropical storm in miami and no fib eventho a lot of strees has occured…which normally i would kick up the afib!!
      Have a good day..Guy

  • Judy Spock

    I have lost weight on Pradaxa and am better for it. Grateful.

    • Gerry

      I have been on Pradaxa for 2 years with no problems at all. I never get any bruising unless I hit something and then the bruise is gone in a couple of days.They check my blood every 6 months.

  • John

    So I suffered from Pulmonary embolism secondary to prostatectomy 2 weeks ealier. Have been on warfarin for a month and dr brought up pradaxa along with safeway pharmacist. Dr. Says need to stay on thinner for 6 months as it takes about 3 months for clots to go away. Should I stick with coumadin or switch to pradaxa?