Posted on 09/29/2009 9:51:59 AM PDT by decimon
In an article reviewed by F1000 Medicine Faculty Members Robert Ruff, Brian Olshansky and Luis Ruilope, the blood-thinner dabigatran is shown to protect against stroke, blood clotting and major bleeding as effectively as warfarin, but with fewer side effects.
The original paper, Dabigatran versus warfarin in patients with atrial fibrillation, by Neal Devaraj and Stuart Connolly et al. in the New England Journal of Medicine, says warfarin (also commonly used in rat poison) has several drawbacks. Finding the correct dosage requires careful and laborious monitoring, and the risk of major bleeding has led to it being under-used.
With fewer side-effects and complications than warfarin, the reviewers see many potential benefits from dabigatran. According to Olshansky, it is "perhaps one of the important drug discoveries in the past decade."
Ruilope says that according to the investigators, "This oral anticoagulant prevents strokes and peripheral embolic events in patients with atrial fibrillation significantly better than that much older drug (warfarin) at different doses. It is also safer than warfarin with respect to major bleeding events."
"An immediate change of practice is not warranted but a change in standard anticoagulant therapy may be needed," Ruilope says.
I wonder about the cost of this drug vs. warfarin.
Once I transported a patient who had an abdominal bleed while on warfarin. A drug that makes that less likely is highly desirable.
I called the cardio and he told me to just take him off and put him on two baby aspirins a day.
I ran to the pharmacist and he told me he knew of these changes all the time.
It's a racket to keep the blood labs busy in my opinion.
mark
My humorous dyslexia kicked in for a second, I read the drug as Dagnabitran
Why not use Plavix?
Warfarin is the frontline treatment, presumably because it is more effective.
“The atrial fibrillation clopidogrel trial with Irbesartan for Prevention of Vascular Events (ACTIVE W) is a noninferiority trial comparing anticoagulation with warfarin to therapy with aspirin plus clopidogrel for stroke prevention in patients with atrial fibrillation. ACTIVE W enrolled 6706 patients and is the largest atrial fibrillation anticoagulation trial completed to date. Patients in ACTIVE W could have either paroxysmal atrial fibrillation or sustained (ie, persistent or permanent) atrial fibrillation. ACTIVE W was halted when warfarin anticoagulation was observed to be superior to aspirin and clopidogrel.”
http://www.accessmylibrary.com/article-1G1-173234220/warfarin-vs-clopidogrel-plus.html
Plavix plus aspirin is used when the patient can’t/won’t tolerate warfarin. They have different mechanisms of action: Plavix interferes with platelet aggregation; warfarin by interfering with the production of coagulation proteins.
But I wonder which came first, warfarin for rat poison or for human's...It does cause the rat to bleed to death.
The willow tree strikes again.....!!
You can get warfarin as a generic (coumadin). Coumadin qualifies as a $4.00 generic under most pharmacy plans.
Excellent slogan! Give the guys in Marketing a raise!
"Old Lace TV Dinners. Safer than rat poison."
Cost dabigatran $7.85/day = $240/month compared to $4/month warfarin + cost of blood tests. Plus cost of complications and events for each.
The testing costs break it for some people. We had a patient whose bipolar disorder was well-controlled on lithium ($4/month) but as she had no insurance and couldn’t afford the blood tests she ended up on a psych unit a few times a year costing the hospital and state taxpayers several thousand each time.
Poison first. I think it was discovered when livestock ate some forage that caused them to bleed to death when castrated.
OUCH just adds insult to injury...
Disclaimer: Opinions posted on Free Republic are those of the individual posters and do not necessarily represent the opinion of Free Republic or its management. All materials posted herein are protected by copyright law and the exemption for fair use of copyrighted works.