Deep Vein Thrombosis (DVT) Support Group
Deep-vein thrombosis, also known as deep-venous thrombosis or DVT, is the formation of a blood clot ("thrombus") in a deep vein. It can be caused by something preventing blood from circulating or clotting normally. Join the support group if you are coping with DVT and find others who are going through the same challenges.
For those interested, I had just updated an older article I had written over at the www.stoptheclot.org website regarding the new oral anticoagulants in the pipeline. Most of the new medications have since been approved by the FDA here in the U.S. so I wanted to update my orginal article to cover that information.
"By now, most DVT/PE survivors are aware of the new oral anticoagulants available or coming to market. This update will address all three medications:
Xarelto (rivaroxaban) (Janssen Pharmaceuticals) In the U.S., Xarelto is approved by the Food and Drug Administration (FDA) for:
(1) prevention of blood clots following hip and knee replacement surgery;
(2) reducing the risk of stroke and to prevent blood clots in patients with atrial fibrillation (not resulting from heart valve problems);
(3) and to treat patients with acute DVT/PE and to reduce the risk of reoccurrence.
(4) Other trials being conducted with Xarelto include DVT/PE prophylaxis for cancer patients.
Pradaxa (dabigatran) (Boehringer Ingelheim Pharmaceuticals) In the U.S., Pradaxa has been approved by the Food and Drug Administration to:
(1) reduce the risk of stroke and to prevent blood clots in patients with atrial fibrillation (not resulting from heart valve problems.)
(2) Other trials being conducted are with Pradaxa include treatment of acute coronary syndrome (ACS).
Eliquis (apixaban) (Bristol-Myers Squibb/Pfizer/) In the U.S., Eliquis has been approved by the Food and Drug Administration to
(1) reduce the risk of stroke and to prevent blood clots in patients with atrial fibrillation (not resulting from heart valve problems).
(2) Apixaban is nearing completion from phase III trial for treatment and for prevention of reoccurrence of DVT/PE. There are additional ongoing trials for DVT/PE prophylaxis in cancer patients, and treatment of acute coronary syndrome (ACS).
Pros of new oral anticoagulants:
Medications affect anticoagulation rapidly. Because of this, initial treatment with heparin or low molecular weight heparin for patients with DVT or PE may not be necessary and there is no need to transition to warfarin. Likewise, the length of time medications affect anticoagulation remain in your system is shortened (short half-life); therefore, you are able to remain on medications until shortly before the surgery without having to bridge for surgeries (ex: Coumadin and Lovenox, Fragmin, Innohep). Medications do not require routine coagulation monitoring. Fewer food and drug interactions. No limitations with vitamin K intake.
Cons of new oral anticoagulants:
Shorter half-life can be dangerous in patients who often miss dosages. With Coumadin, its anticoagulant effects remain in your body longer. No reversal agents available, i.e. difficult to manage serious bleeds in case of emergency. No established monitoring anticoagulation test widely available at this time. This is of particular concern to patients with kidney or liver disease or severe obesity or underweight where dose adjustments may be desirably."
The out of pocket expense for the new drugs is approximately $10 per day (equating to about $300 per month). Co-pay amounts will vary. Warfarin as a drug is cheap, however, the monitoring can be very expensive. INR visits may cost as much as $110 for a finger stick per each visit. If you take in to account Coumadins monthly medication fee along with costs of INR tests, the numbers start to draw closer in comparison. Some co-pays for medications like Xarelto may run from $4 all the way to $60 per month (depending on your insurance). So for some patients, the new medication overall may be cheaper per month."
So, are the new oral anticoagulants right for you? That's really up to discussion between you and your doctor. I had made the switch to Xarelto after being on Coumadin for almost 20 years. So far so good but only time will tell if there are any long term complications associated with the medication. For this reason, Coumadin will remain the go-to medication used by most doctors.
R/Tom
"By now, most DVT/PE survivors are aware of the new oral anticoagulants available or coming to market. This update will address all three medications:
Xarelto (rivaroxaban) (Janssen Pharmaceuticals) In the U.S., Xarelto is approved by the Food and Drug Administration (FDA) for:
(1) prevention of blood clots following hip and knee replacement surgery;
(2) reducing the risk of stroke and to prevent blood clots in patients with atrial fibrillation (not resulting from heart valve problems);
(3) and to treat patients with acute DVT/PE and to reduce the risk of reoccurrence.
(4) Other trials being conducted with Xarelto include DVT/PE prophylaxis for cancer patients.
Pradaxa (dabigatran) (Boehringer Ingelheim Pharmaceuticals) In the U.S., Pradaxa has been approved by the Food and Drug Administration to:
(1) reduce the risk of stroke and to prevent blood clots in patients with atrial fibrillation (not resulting from heart valve problems.)
(2) Other trials being conducted are with Pradaxa include treatment of acute coronary syndrome (ACS).
Eliquis (apixaban) (Bristol-Myers Squibb/Pfizer/) In the U.S., Eliquis has been approved by the Food and Drug Administration to
(1) reduce the risk of stroke and to prevent blood clots in patients with atrial fibrillation (not resulting from heart valve problems).
(2) Apixaban is nearing completion from phase III trial for treatment and for prevention of reoccurrence of DVT/PE. There are additional ongoing trials for DVT/PE prophylaxis in cancer patients, and treatment of acute coronary syndrome (ACS).
Pros of new oral anticoagulants:
Medications affect anticoagulation rapidly. Because of this, initial treatment with heparin or low molecular weight heparin for patients with DVT or PE may not be necessary and there is no need to transition to warfarin. Likewise, the length of time medications affect anticoagulation remain in your system is shortened (short half-life); therefore, you are able to remain on medications until shortly before the surgery without having to bridge for surgeries (ex: Coumadin and Lovenox, Fragmin, Innohep). Medications do not require routine coagulation monitoring. Fewer food and drug interactions. No limitations with vitamin K intake.
Cons of new oral anticoagulants:
Shorter half-life can be dangerous in patients who often miss dosages. With Coumadin, its anticoagulant effects remain in your body longer. No reversal agents available, i.e. difficult to manage serious bleeds in case of emergency. No established monitoring anticoagulation test widely available at this time. This is of particular concern to patients with kidney or liver disease or severe obesity or underweight where dose adjustments may be desirably."
The out of pocket expense for the new drugs is approximately $10 per day (equating to about $300 per month). Co-pay amounts will vary. Warfarin as a drug is cheap, however, the monitoring can be very expensive. INR visits may cost as much as $110 for a finger stick per each visit. If you take in to account Coumadins monthly medication fee along with costs of INR tests, the numbers start to draw closer in comparison. Some co-pays for medications like Xarelto may run from $4 all the way to $60 per month (depending on your insurance). So for some patients, the new medication overall may be cheaper per month."
So, are the new oral anticoagulants right for you? That's really up to discussion between you and your doctor. I had made the switch to Xarelto after being on Coumadin for almost 20 years. So far so good but only time will tell if there are any long term complications associated with the medication. For this reason, Coumadin will remain the go-to medication used by most doctors.
R/Tom
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