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Q) I am sick of doing all the blood work that warfarin requires, but I am reluctant to change to the newer blood thinners since there is no way to reverse their effects in the event I get into an accident. When is this going to change?
A) The good news is that the drug companies have finally come up with a relatively quick way to reverse the blood thinning abilities of one of the new anticoagulants in the event of uncontrolled bleeding (like after a car accident or perhaps in advance of emergency surgery).
The new drug is called Praxbind (idarucizumab) and when given intravenously it can fully reverse the effects of Pradaxa (dabigatran) within 4 hours for the vast majority (89%) of recipients.
This is good news for many of my patients as no one particularly enjoys spending hours every month in a line up waiting to have their blood taken in order to adjust their warfarin dose.
However, the fear of a major bleed has stopped some of them from making the transition to any of the 3 new blood thinners (Pradaxa, Eliquis & Xarelto) that do not require this testing in order to be safely taken.
With warfarin, should you be involved in some kind of incident and were rushed to a hospital, the administration of vitamin K would quickly reverse warfarin’s effects greatly diminishing the risk of you literally bleeding to death.
For the 3 newer drugs only time and supportive measures (the ingestion of activated charcoal to reduce the absorption of the drug and the use of assorted blood products) were available as the emergency staff would attempt to keep the patient stable until the effects of the blood thinners wore off.
Praxbind changes all that, but it does so only for the one blood thinner, Pradaxa. This is because Praxbind is an IV monoclonal antibody that exhibits its effect by actually binding onto Pradaxa (hence its name) thereby preventing the blood thinner from exerting its effects on one of the many chemicals (called clotting factors) that are responsible for our blood’s ability to clot.
As such, both Xarelto and Eliquis still do not have an effective reversal agent to their blood thinning activities. Praxbind is given either as 2 separate IV infusions each lasting 5 to 10 minutes or combined as a single injection given by a syringe. The drug can be given to virtually anybody as there are no contraindications to it (this is a medical term we use to list all the people who should not take a particular drug).
Being an antibody, there is a risk of an allergic reaction, but these risks are present with all medications and were it to occur no one would argue that at least you are in the right setting to deal with it. It also contains sorbitol within its formulation so this with hereditary fructose intolerance would be at an increased risk of suffering an adverse reaction.
Lastly, patients are put on Pradaxa for a reason so reversing its actions does put the patient at risk of having a clot and all the attendant ramifications from that (i.e. strokes or heart attacks). That being said, regular blood thinning treatment can be resumed in as little as 24 hours later, provided the bleeding has been stopped already of course.
This news should help even more patients make the change over from warfarin as science has already proven that as a whole all three new anticoagulants are at least as effective and safe as warfarin and require a whole lot less time (and tax payer money) to be taken safely.
For more information about this or any other health related questions, contact the pharmacists at Gordon Pharmasave, Your Health and Wellness Destination in Kincardine and Port Elgin.
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Thursday, August 18, 2016