An Alternative to Coumadin in Patients with Atrial Fibrillation

Pradaxa is a new anticoagulant medication which is an alternative to Coumadin in many patients with atrial fibrillation. Studies have shown that Pradaxa may be slightly more effective than Coumadin in preventing strokes in patients with atrial fibrillation. Pradaxa works through a different mechanism on the clotting system and therefore does not require any type of monitoring or “finger sticks.” It is taken at a fixed dose twice a day and is adjusted only if there is any impaired kidney function. It is not affected by diet and has very few drug interactions.

The advantages to Pradaxa include its fixed dosing, no need for “finger sticks,” lack of interaction with foods and drugs, and its increased efficacy at preventing strokes.

The disadvantages include the twice daily dosing, its high cost if not covered by insurance, and a very slight increase in stomach bleeding. (It does have a lower rate of brain hemorrhage.) In addition, patients with any impaired kidney function will be required to take a lower dose.

In regards to medical/surgical procedures being performed on patients, Pradaxa should be treated very similarly to Coumadin. It will need to be held for 2 to 5 days depending on the procedure. This will need to be discussed with your doctor.
To summarize:

1. Pradaxa can replace Coumadin in many patients with atrial fibrillation.
2. There are no diet restrictions or antibiotic interactions.
3. No monitoring is required.
4. The medication must be taken twice daily.
5. Prior to procedures, Pradaxa must be stopped for two to five days.

Please feel free to discuss this new treatment for atrial fibrillation with your physician. While this is certainly a great and potentially wonderful advance for patients on anticoagulation, we want to be as safe and careful as possible with our patients.