New anticoagulant Pradaxa offers benefits over mainstay Coumadin

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Three different heart groups — the American Heart Association, the American College of Cardiology and the Heart Rhythm Society — all have just announced that the recently approved anticoagulant dabigatran (Pradaxa) should be considered as an alternative to warfarin (Coumadin) as treatment for patients suffering from atrial fibrillation.

Researchers have concluded that Pradaxa offers some significant advantages to Coumadin. In particular, patients on Pradaxa have a lower risk of bleeding and therefore need less monitoring for changes in clotting parameters. ACSH's Dr. Gilbert Ross notes that patients being started on Coumadin have to be tested for this daily, and, even years later, they must be tested at least monthly to avoid bleeding complications.

Both drugs reduce the risk of systemic emboli, clots that form in the atria in patients with atrial fibrillation and travel to, most worrisomely, the brain, causing strokes. Research has not shown a difference in mortality for patients treated with one drug rather than the other. But a disadvantage of Pradaxa is that it must be taken twice daily while Coumadin only needs to be taken once.

Dr. Ross says that the findings are “very important nonetheless. At the same time, in reading about these new guidelines, I was amazed to learn that 40 percent of patients with atrial fibrillation are not receiving a prescription for an anticoagulant. Unless a doctor has a good reason not to prescribe one of these drugs for a specific patient, that seems questionable. These are standard treatment protocols.”