New blood thinners compete with old anticoagulants. Pradaxa / dabigatran. Xarelto / rivaroxaban. Eliquis / apixaban. How safe and effective are new oral anticoagulants? Should you choose warfarin or new blood thinners?
Transcript of video
New blood thinners. New oral anticoagulants. New oral anticoagulants discussion with top Boston cardiologist. What are advantages and risks of novel oral anticoagulants? New blood thinning medications do not require laboratory testing. This is different from classical anticoagulant warfarin (Coumadin). Dr. Anton Titov, MD. How safe are new blood thinners? How to use new anticoagulants properly? What are risks of new blood thinning medications? Reversal agents for new oral anticoagulants. Video interview with top expert in cardiology. Second opinion ensures that need for anticoagulation is present. Second opinion also helps to choose the best selection of medications for anticoagulation. Dr. Anton Titov, MD. Seek second opinion on need for anticoagulation in atrial fibrillation or deep venous thrombosis and be confident that your treatment is the best. New blood thinners / novel oral anticoagulants discussion (Pradaxa / dabigatran and Xarelto / rivaroxaban / Eliquis / apixaban). Second Opinion (Cardiologist, Professor of Medicine, Harvard Medical School). Dr. Dale Adler, MD. The newer oral anticoagulant medications really represent a terrific breakthrough. So patients don’t have to get their blood checked. This is wonderful. At extremes of patient population the level of new anticoagulant medications in the blood will probably be a little too low or too high. So a patient who is very very thin probably will have a higher levels of new blood thinner medications than average. Patient who is very very heavy will probably have a lower blood level of new oral anticoagulant. (Pradaxa, Eliquis or Xarelto). Patients who are elderly probably will have more problems. Dr. Dale Adler, MD. Serum levels of new oral blood thinners in patients with kidney dysfunction probably are not going to be so accurate. Second Opinion (Cardiologist, Professor of Medicine, Harvard Medical School). The beauty of the new oral anticoagulant medications (dabigatran and rivaroxaban) is decrease in bleeding in the head (intracranial hemorrhage). New oral anticoagulants are Dabigatran, Rivaroxaban, Edoxaban, Apixaban. These are novel blood thinner medications. All novel anticoagulant medications have lower incidence of bleeding in the head (intracerebral hemorrhage). Incidence of bleeding in the head during use of oral blood thinner medications is low to begin with. These new oral anticoagulants seem to decrease risk of bleeding in the head (brain hemorrhage) in all studies. Bleeding in the head was decreased by 50%. Brain hemorrhage decreased even 75% in pre-approval and post-marketing clinical trials of novel oral anticoagulants. And that makes us feel much better about using these new oral blood thinner medications. We are not happy if somebody has a higher incidence of gastrointestinal bleeding. Dr. Dale Adler, MD. But we are happy if a patient does not have a bleeding into the head (brain hemorrhage). We are happy that patients don’t have a stroke. We can usually treat gastrointestinal bleeding. Medical Second Opinion. Dr. Anton Titov, MD. Can we go back to discussion of new oral anticoagulants, novel blood-thinning medications? (these are Dabigatran, Rivaroxaban, Edoxaban, Apixaban). Some surgeons are concerned that blood thinning action of these novel oral anticoagulants is not reversible. Dr. Dale Adler, MD. Sometimes there is an acute situation. There is trauma or need for urgent surgery. It is possible to quickly reverse blood thinning action of older anticoagulant (warfarin / Coumadin) with vitamin K injection. Blood thinning effects of novel oral anticoagulants (Pradaxa, Xarelto, Eliquis) cannot be quickly reversed. Dr. Anton Titov, MD. Are there medicines that reverse action of new oral anticoagulants? Will there be new medications to reverse novel oral blood thinners? Second Opinion. Yes, it’s an all-important question. Yes, there are some new medicines in development that can reverse blood thinning action of new oral anticoagulants in emergency situations. Reversal of new oral anticoagulants can be done. Some reversal medications are antibodies to novel anticoagulants. Other reversal agents for new oral blood thinners promote clotting by an alternative pathway. IDARUCIZUMAB, an antibody to dabigatran. ANDEXANET and ARIPAZINE are developed to reverse apixaban, edoxaban, rivaroxaban. Most patients feel that probably within the next even many months we will have a good medicine to reverse anticoagulation from new oral blood thinners. But the other part is a very interesting question. Because duration of action of new oral anticoagulants is much shorter. Sometimes patient stops taking warfarin (Coumadin). It takes 3 to 4 more days for blood thinning action of warfarin (Coumadin) to disappear. Dr. Dale Adler, MD. Novel oral blood thinners have shorter duration of action. Their blood thinning effects are not present in the body after perhaps just 12 hours. That is important. There was also an interesting study done. Patients were admitted to the hospital with bleeding. Some patients with bleeding took new oral anticoagulants. Other patients with bleeding took older blood thinner, warfarin (Coumadin). Vitamin K reversal medication was administered to patients who had internal bleeding and who were on warfarin. The laboratory tests showed reversal of anticoagulation in these patients. Doctors were happy. Dr. Anton Titov, MD. But these patients had more bleeding than patients on new oral anticoagulants. Even though reversal of blood thinning effects of medication could not be done for patients who took novel blood thinners. And there was no laboratory data to follow the reversal of their anticoagulation. But they had less clinical bleeding. So there is always the difference between what you see on the laboratory study and what is actually happening in real clinical situation. New blood thinners do not require blood tests. Who benefits most from new oral anticoagulants? What are risks of new blood thinners (Pradaxa, Xarelto, Eliquis)