I have become an AF-doctor. That means my most exciting aspect of medicine is terminating AF with watts delivered through a catheter. “Got it.” In that beautiful moment, the take-the-fun-out-of-medicine people seem far away. Huge grin! Though all that high-tech stuff is exhilarating, it’s fair to say that the most remarkable thing in AF medicine […]
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Almost everything about the new blood-thinning drug, dabigatran (Pradaxa) is novel. In February, I wrote about the drug’s unusually short (thirty-day) expiration time. This week, the FDA has released a new communication concerning dabigatran. It included practical safety tips for patients, pharmacists and doctors, and is nicely summarized by Larry Husten, on Cardiobrief. Here are […]
I hope we are right. Dabigatran (Pradaxa) use in my community has taken off. It’s not just AF-doctors, it’s all doctors, internists and cardiologists alike. Honestly, it’s a little scary. That’s why I read with great interest anytime other practicing doctors speak about how they use the 4-month-old blood-thinner. Remember, this is not a just […]
There was important news concerning the short shelf-life of the novel new blood-thinner, dabigatran (Pradaxa) reported today. Once dispensed, most medicines expire after a year. Dabigatran, however, is far from the usual pill. It’s packaged in pellet form within a capsule. These pellets are highly susceptible to water and humidity. So when dispensed in a […]
Yesterday marked the two-month anniversary of the availability of the novel blood-thinner dabigatran (Pradaxa). It was approved for the use of preventing stroke in patients with non-valvular AF, but it has quickly taken on the inaccurate moniker of “the warfarin-substitute.” Here’s the thinking: If stroke prevention in AF is accomplished by thinning the blood, and […]
I remember in high school, as an assignment, I wrote a letter to a prominent business person. I will try it again. In 2010, this would be an e-letter. To: J Martin CarrollCEO of Boehringer Ingelheim Corporation: The makers of the recently-released exciting new oral blood-thinner, dabigatran (Pradaxa). Dear Sir, To start off on a positive […]
We have to talk about drugs. No, not illicit drugs, but medications used by doctors and patients. Plaintiff attorneys run ads on TV that fool people into thinking certain meds are bad. The current one I deal with is the clot-blocking drug rivaroxaban (Xarelto.) Before that, it was dabigatran (Pradaxa). If, or when, the makers […]
Times have changed in the treatment of patients with atrial fibrillation (AF). First some background: The first of the four pillars of AF care is stroke prevention. The only proven means to protect patients with AF from stroke is use of drugs that block clotting factors–or anticoagulants. Some people call these drugs blood thinners. I […]
Cardiology is on the brink of making a big mistake. We have embraced a new procedure called left atrial appendage occlusion. You may be seeing the ads for a device called Watchman. Like this one> The appendage-closure idea was a good one: during atrial fibrillation (AF), blood can pool in the left atrial appendage, and […]
Here is my most recent column on theHeart.org | Medscape Cardiology: Mandrola’s Top 10 Cardiology Stories 2015 What follows below is a short-writing summary of my ten picks. The hyperlinks go to earlier columns I wrote on the topic. 1. The FDA approved two new (injectable) cholesterol drugs. The problem with the PCSK9-inhibitors: the study […]
I receive many emails about AF. I don’t often answer them because it is bad practice to doctor without seeing the person. Recently, however, I received a note with more general questions. The sender suggested I could use the response as a blog post. The reason I am posting these two cases along with my […]