Why would a doctor prescribe Xarelto® or Pradaxa®?
You might wonder why a doctor would ever prescribe a medication that tampers with something as fundamental as the blood’s ability to form clots. After all, it is that coagulating characteristic which prevents the blood from emptying out of the body like air from a punctured balloon when you get a paper cut, have a tooth pulled, or undergo surgery.
- People with atrial fibrillation (an irregular heart beat) are at increased risk of forming a blood clot in the heart. If a clot forms, it may travel to the brain, causing a stroke, or to other parts of the body. A medication that lowers the blood’s clotting tendency helps prevent clots from forming and reduces the risk of stroke.
- People with deep vein thrombosis (DVT), a blood clot in a deep vein, usually in the legs, are at risk of having the blood clot break away and travel to the brain, causing a stroke, or travel to the lungs, causing pulmonary embolism (PE). Although not always fatal, both DVT and PE cause discomfort and reduce quality of life, and both require immediate treatment. Blood thinners can help alleviate DVT and PE and reduce the risk of these conditions recurring.
- Surgery on the legs, as in knee and hip replacement, displaces the deep leg veins and increases the risk of DVT. Blood thinners administered following surgery reduce this risk.
Once it is established that a patient needs to take anticoagulation medicine, or a blood thinner, a specific drug must be selected. There are several options, including warfarin (Coumadin, Jantoven), which has been the go-to anticoagulation therapy for the past 60 years. However, there are drawbacks associated with warfarin. The physician must prescribe a specific dose for each individual. At the outset of warfarin therapy, the patient will likely have to visit the doctor’s office every day for blood tests until the exact dose can be established. The patient must also return regularly for additional testing and possibly dose adjustments as a result of changing blood chemistry, overall health, and other factors. This is inconvenient, time consuming, and costly for doctor and patient. In addition, warfarin also interacts negatively with several other medications and foods (primarily green, leafy vegetables), making it a complex drug to manage.
Pradaxa® and XARELTO®, in contrast, have been heavily marketed as a much simpler drug. Both are prescribed in a uniform, once-a-day dose and has fewer negative interactions, making it easier to cope with and less time consuming for both doctors and patients. According to the manufacturers, with Pradaxa® and XARELTO®, there’s no routine blood monitoring, so the patient does not spend as much time on doctor’s visits; there are no dietary restrictions, so the patient is free to enjoy any foods; and there are no dosage adjustments, which means the patient can take just one pill a day.
Because of these purported advantages, Pradaxa® and XARELTO® very quickly became a very popular treatment option for patients needing anticoagulant therapy, despite the fact that they are significantly more expensive (approximately $3,000 per year) than warfarin ($200 per year).