New Drug Eliminates the Hassle of Coumadin (warfarin)

Dr. Sharon Orrange
Dr. Orrange is an Associate Professor of Clinical Medicine in the Division of Geriatric, Hospitalist and General Internal Medicine at the Keck School of Medicine of USC.
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What’s the story with Pradaxa (dabigatran)?

The buzz created by the heavy marketing campaign from Boehringer Ingelheim, the makers of Pradaxa, has made its mark because many of my patients are asking: what’s the story with the new and better warfarin? Physicians and patients alike have been anticipating the arrival of this new blood thinner because it eliminates the need for weekly blood tests to check levels. So, it is worth the buzz?

Coumadin (warfarin) has been the mainstay of treatment for those with atrial fibrillation (the most common kind of abnormal heart rhythm) to prevent stroke. One of the huge downsides of warfarin is that patients need to be monitored with blood tests to check their INR levels (to measure whether the level of blood thinner is appropriate). That’s a hassle when it means coming to visit the doctor or pharmacist every 1 – 3 weeks.

Pradaxa (dabigatran) eliminates the need for visits to check blood levels, resulting in an immediate love affair with both physicians and patients. Hold on though; let’s make sure we know the facts. Pradaxa is used to reduce the risk of stroke in patients with atrial fibrillation who don’t have significant valve disease, which we call non-valvular atrial fibrillation.

Pradaxa 150 mg twice a day reduces the risk of stroke in those patients with fibrillation often more effectively than warfarin. Pradaxa also resulted in fewer cases of intracranial hemorrhage (bleeding in the brain) than warfarin and that’s all good.

Now what are the downsides of Pradaxa? The first obvious one will be cost, because Pradaxa will be much more expensive than warfarin. Pradaxa also resulted in a higher rate of major gastrointestinal (GI) bleeds and of GI bleeds in general compared to warfarin. In patients 75 years and older the risk of major bleeding may be greater with Pradaxa than with warfarin. Finally, the risk of heart attack was slightly higher in patients who received Pradaxa than in those on warfarin: 1.5% vs. 1.1%.

So is eliminating visits for INR checks worth it? You and your doctor will decide.

Dr O.

Generic warfarin should be covered by most insurance plans as a Tier 1 generic, meaning you’ll pay your minimum copay. Warfarin may also be available for as little as $4 for a 30-day supply. Pradaxa was introduced last year and does not have a generic equivalent. It is considered a Tier 2 drug by many insurance plans, meaning you’ll pay a moderate copay. Pradaxa is typically $230 – $250 out of pocket for a 30-day supply.

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