Recently, various players in the pharmaceutical sector have introduced a brand new line of anticoagulant drugs (popularly called “blood thinners,” ) that have guaranteed to make life much easier for physicians who treat patients at risk for stroke. A stroke of course is the consequence of a blood clot that cuts off blood supply to the mind, and can lead to permanent injury and maybe even death.
For decades, the conventional medication used to prevent clotting was a type of rat poison called warfarin. It is derived from a material called coumarin, a biochemical seen in woodruff and sweet clover (which gives these plants their agreeable scent).
The Federal Drug Administration in 1954 approved the blood thinner warfarin to help lower the chance of blood clots leading to stroke for the more than 2 million Americans who have an abnormal heart rhythm called atrial fibrillation. For many years, warfarin (Coumadin) was the only medication available.
The drawback of Warfarin is that it needs constant patient monitoring, due to the variety of likely future interactions with other drugs too as certain foods (such as leafy greens, which include high rates of Vitamin K). By giving the patient high doses of Vitamin K., yet, hemorrhaging can be controlled easily
Advantage of using the brand new Factor Xa inhibitors as Xarelto is that there are relatively few interactions – and hence, less (expensive) patient observation is required. If uncontrolled bleeding does occurs, there is absolutely no strategy to stop it – other than to place the patient on emergency dialysis to be able to get the drug out of the system as fast as possible. Even a slight bulge on the head can be deadly.
Here are the key differences between the two blood thinners that have become so popular.
1. Xarelto works otherwise. Patients need continuous testing to determine dosage, although with less vitamin K in circulation, blood takes more time to clot. Vitamin K doesn’t change, and continuous monitoring isn’t needed.
2. Dosage. For stroke risk reduction, the typical dose of Xarelto is 20 milligrams once a day, taken with the evening meal, based on WebMD. The optimal dosage of Warfarin can depend on diet, age and other drugs and varies from person to person. “The dosing is delicate,” said WebMD. “Give too much, and the risk of bleeding rises, sometimes alarmingly. Give too little, along with the stroke risk stays.”
3. Cost. Xarelto is more expensive for all those without insurance. But since insurance usually covers Xarelto, for those with coverage the price differences would be minimal. In some instances, the out-of-pocket price for Xarelto is lower than Warfarin.
4. Bleeding. Warfarin carries a risk of brain hemorrhage, which is uncommon but fatal. Although significant bleeding events occur less frequently when taking Xarelto than with warfarin, they could happen. Luckily the serum half-life of Xarelto is comparatively brief — five to nine hours — so its effect will vanish within about 24 hours.
5. Dietary issues. Patients on warfarin must get blood tests at least monthly and see their consumption of Vitamin K, a nutrient that could lessen the effectiveness of warfarin and can be found in leafy green vegetables like spinach, chard and kale. No dietary dilemmas are found with Xarelto.
6. Hips and knees. In studies on hip and knee replacement patients, those taking Xarelto were much less likely than those on other anti-clot therapies, including warfarin, to have clot issues, according to WebMD.
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