@purplemem,

Thank you for posting that and I'm interested to know about what the new protocols might be.

I joined theheart.org and can't find the article you're talking about

"Role Reversal: Hematologists Advise on Bleeding With Newer Anticoagulants" (I entered that in their search box and no hits)

I also couldn't find any information about how Baylor U. is involved.

If you wouldn't mind, could you post the url/link of that article. (Copyright issues prevent you from posting the article in it's entirety.)

Thank you.
A lot of good stuff on that site.

If you google the name of the article a couple of hits come up:

http://www.theheart.org/article/1418551.do

I don't see where Baylor is referenced either. Is that a different article, maybe or am I missing it?

Anyway, thanks for posting this info, purplemem.

You are both looking at the second article, dated August. The article I am referencing is dated Medscape June 21, 2012.
http://www.medscape.com/viewarticle/766211

I have a sign-in that is free.

No, the one I referenced is date 6/21/2012.

" although more work is needed to pinpoint the correct doses of these to use,"

Although work is under way to develop specific antidotes for these new drugs, "it may take years" until these are on the market,"

Is this what you were talking about?


I believe that it's being conducted in vitro, not in vivo. But I could be wrong?

"They are very simple: a partial thromboplastin time (PTT) and an activated partial thromboplastin time (aPPT), which are available 24/7, and then we give a standard dose of PCC. We give 50 units/kg, and in fact our protocol--which is an electronic order--actually just gives a standard dose of 4000 units to make it simple, because the people doing this are often ER doctors or surgeons, they are not hematologists."

In 2011 the protocol was not approved in the U.S.. Perhaps it is now? Do you have new information that says it is?

http://www.medscape.com/viewarticle/766211

"PCCs that contain all 4 (including factor VII) of the vitamin Kdependent clotting factors (4-factor PCCs) are approved in the European Union, but are not approved in the United States. The approval status of 4-factor PCCs also varies in other countries such as Canada and Australia"

http://bloodjournal.hematologylibrary.org/content/117/23/6091.full

According to the article, this is what they are using at the University of Texas Southwest Medical Center. This is all the information I know but was more than my doctor had and appreciated the info.

"She [Rutherford from UT in Dallas] also believes this approach with PCC will work better for factor Xa inhibitors than for dabigatran and related products.

She noted they do measure thrombin time, and if it's normal, she says, the patient has likely excreted the drug. But in the absence of any other strategy, they also use PCC for reversal of dabigatran bleeding, "but we don't know if it helps," she admitted."

purplemem----- aren't you on dabigatran ( Pradaxa)? Seems she and others thinks that protocol works better with the other new anticoag meds.

yes, but I've also been on Xarelto. You are right, though, this will not help Pradaxa so phooey - never mind this find!

purplemem-------- well, at least you were trying! (grin) But extracting all fine print from a long article takes some persistence!

I hope you never have to have any emergency procedures done because of unstoppable bleeding. That's the main reason I haven't switched over to Pradaxa.

purplemem, posting that information is fine. There are no medical professionals here and no one is an expert so it's just sharing info and people can do with it what they want.

I'm not on pradaxa either, not because there's no reversal agent, but rather because it can be hard on the liver, and I'm at risk for liver issues due to other medication I take. But otherwise, if I could, I'd consider going on it at some point. I suspect your doc has informed you of all the risks and I gotta say, I appreciate all the people in the DVT and PE groups who are giving pradaxa a try right now, because it helps us understand the drug better in the long run and paves the way for more of us to consider it in the future. So thanks!

Purplemem I too appreciated seeing this information and am really glad that you shared it. It's good to be well informed as to the protocols for the newer medications, especially for those of us who are either already on long-term anticoagulants or have resigned ourselves to the probability of future long-term use. And please don't feel that the information was moot, it absolutely was not. I don't know what's so hard to interpret about "this approach with PCC will work better for factor Xa inhibitors than for dabigatran and related products." Working *better* on Xa drugs doesn't necessarily mean that it doesn't work at all for the other. Hence leading to this conclusion: "But in the absence of any other strategy, they also use PCC for reversal of dabigatran bleeding, 'but we don't know if it helps,' she admitted." So yes, the information you posted is absolutely relevant since despite the fact that they don't know if it helps, this is apparently still the protocol in use at this time until something more effective is develped. I actually personally wouldn't use dabigatran right now because of this issue, but if I were on it, you bet I'd carry around information on the most up to date protocol for dealing with bleeding should it happen. So again, thank you for sharing the information, since I know a lot of people on this site are looking into and some taking the newer anticoagulants.

rmb said:
*** I appreciate all the people in the DVT and PE groups who are giving pradaxa a try right now, because it helps us understand the drug better in the long run and paves the way for more of us to consider it in the future****

Yes, same with me. All those people are now participating in Phase 4 of the drug (whether they know it or not). That's when a new drug is already being sold and any good or bad effects are being monitored by the FDA.

I'm happy to stand aside and let them be the trial population.

I won't take a 'new' drug until the 'shake-out' period has been around for many years; in recent years a lot of new drugs have been rushed to market with less oversight and in less time.

I was encouraged that SOMEBODY was working on an antidote. I cannot take coumadin so I only have Xarelto and Pradaxa to use. My copay for Xarelto was over $100 but my doctor has Pradaxa samples at this time. My other meds cost me $$$ so I needed to get what I could the cheapest way I could.

Please don't tell me there are companies that help with meds. I have medicare and they will not help until in the donut hole, and then, last year they would not help then either. I went without meds for two months last year and ended up in the hosp for most of December.

purplemem
Please don't shoot me! (grin) But I've been doing patient assistance for SO long that saying 'nothing can be done' is like a red flag to a bull. :) I was able to (legally) get payment from Medicare for doctor visits that had opted out of Medicare. Took a bit of doing but it was all there, on the Internet, hidden under layers and layers of 'stuff'.

In the off chance that perhaps you or your doctor hasn't found this. (Probably have, but since I don't know what all you've tried....... here goes.)

http://tinyurl.com/cgunx2m

[Boehringer Ingelheim CARES Foundation]

Since I don't know details about your finances (don't need to) and other personal stuff I'll be flailing around a bit so forgive me if all this is redundant.

If you care to send a private message to me I'd be glad to try and help you. TRY----- no promises but I've had a pretty good track record in the past.

Here is something about Pradaxa protocol, which is basically to dialyze the patient from Hennepin County, which is Minneapolis/St Paul.

I had a doc tell me about Pradaxa as the next wonder drug for anti-coag. He of course did not mention the lack of a reversal agent.

http://emcrit.org/misc/bleeding-patients-on-dabigatran/

HTH