Atrial fibrillation Dabigatran/Rivaroxaban/Apixaban Health Care

A coumadin substitute, we are almost there…

I have heard this for years, “Doc, that stuff is rat poison!”

But only lately have I heard this, “Doctor M, that company who can’t talk about their drug brought lunch again today.”

Well, it is finally here (well almost), the first warfarin substitute, dabigatran.

Sine antiquity, or at least it seems that long, the blood thinner warfarin has been vigorously maligned by patients and doctors alike. But finally the time is near–the end of a bygone era, perhaps.  The dreaded warfarin is in its final innings.

Today, an advisory panel unanimously recommended to the FDA that Boehringer Ingelheim’s blood thinner, dabigatran (Pradaxa) be approved for the use of stroke prevention in atrial fibrillation.

The landmark Re-LY trial was published in the NEJM in Sept. 2009. It showed that dabigatran was superior to (or at least equal to) warfarin in AF-related stroke prevention. Additionally, it had a lower bleeding risk and did not require any blood-thinning (INR) checks.  I wrote my medical opinion of it here, and about its cost implications, here.

Boehringer Ingelheim should not celebrate too long though, as the warfarin-replacement field is getting crowded with other blood-thinning hopefuls.

Yes, the already complex decision-making in AF is getting even more challenging.


Ref: Re-LY trial, NEJM, Sept 2009

2 replies on “A coumadin substitute, we are almost there…”

Looks like a potential block-buster. The only remaining issue is drug-drug interactions.

Patients are going to love the convenience of NOT checking INR blood thinning tests.

Free at last! I can't wait to have a warfarin-flushing party for my patients. It's a wonder the all-powerful INR lobby hasn't tried to sink this 😉

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