Posts Tagged ‘anticoagulant’

Dabigatran approved!

October 21, 2010

For the first time in nearly 50 years, patients with Atrial Fibrillation (A-Fib) have a new blood thinning option: Dabigatran. The talk is already starting about how this could replace Warfarin (which is really RAT POISON… we’re just given it in doses too small to kill us!)

One can hope, but there is still a lot that we need to learn about the drug. The US Food and Drug Administration has approved it only as a preventive for stroke caused by A-Fib. Will it even work for anything else? The odds are that it will, but it still needs to be tested. How are people with mechanical valves going to react to it? Somebody’s going to have to take a deep breath and test it. Yet another problem is the cost. Dabigatran is estimated to cost $8 to $12 per day; Warfarin has been around so long that the cost is a pittance. But that is just the cost of the drug – with Warfarin, you also get the required monitoring, in the form of the INR Test. Dabigatran doesn’t require monitoring. Does the cost of Warfarin plus the cost of the test plus supplies make its cost roughly equal with Dabigatran?

There’s another major drawback for certain CHDers: Dabigtran is currently not recommended for “patients with the presence of a severe heart-valve disorder.” That sounds like Tricuspid Atresia patients, Hypoplastic Left Heart Syndrome patients, and those with several other defects are out of luck. Perhaps it is not for us because of lack of testing; if that is the case, the recommendation may change in the future.

At the moment, Dabigatran looks like a drug with a limited potential. Hopefully real world experience will change this.

Don’t be a tough guy!

December 21, 2008

I can guarantee that this Christmas is going to be better than last Christmas!

Last December 10, I had my pacemaker replaced. The battery was running dry, so it was a simple procedure – the operation only took about 45 minutes. After they released me later that day, the hospital staff instructed me to resume taking my medications (including Warfarin) that night.

In retrospect, the Warfarin might have been resumed a bit too soon. My pacemaker is implanted in my left abdomen, just beneath the rib cage. In a few days I had developed a bruise that ran from the incision down to my waist, and stretched from my navel to the small of my back.

And if that wasn’t bad enough, the painkillers weren’t working. Medical personnel will often ask you to rate your pain on a scale of 0 to 10, with 0 being “I don’t hurt a bit.” and 10 being “I hurt too much to die!” They had prescribed Lortab, but I learned that Lortab makes me sleepy, and that’s about it. My pain level was 8+, and I spent most of my waking hours sitting in a wooden straight backed chair.

“Wouldn’t you be more comfortable in a recliner, or on the sofa?” a lot of people asked me, and I’m sure that I would have. But getting seated and getting back up bothered me so much, it was much easier to stick with my wooden chair. At least I could reach a light to read and could see the TV. That’s about all there was to do.

I got an appointment to see my Cardiologist on the 19th… pretty quickly for a doctor’s appointment, but that’s forever when you are hurting. The staff did the blood pressure check, the PulseOx, and then the doctor came in.

“Let me see this bruise you were telling me about,” he asked. I took my shirt off.

“Yowsa!” he said when he saw my king sized bruise. I wondered if that was a recognized diagnostic term.

My doc is on the ball. I left his office with a prescription for a stronger painkiller and another week’s worth of antibiotics just in case. Since I had my new pacemaker implanted at the hospital, the pacemaker team sent someone up to examine me, also. “We’re going to have to rethink our anticoagulant therapy procedures, that’s for sure,” he said.

The new painkillers helped almost immediately, but it was about a month before I felt completely human again, and a six weeks before the pacemaker replacement was just an unpleasant memory.

If you are having heart surgery or any number of cardiac procedures, there is going to be some pain involved, and you may just have to put up with it for a little while. But you shouldn’t just HURT, not to the point that you can’t even sit in a padded chair. That’s the time when you don’t need to be the toughest guy on the planet; call your doctor and get some help.