Xarelto

[Protimenow]

I haven't checked any literature about this new anticoagulant, but I'm seeing a lot of commercials for it. It's apparently only approved for A-Fib, and is being marketed as a way to avoid those, terrible, obtrusive, annoying, expensive (my words) 'monthly trips to the clinic' for testing. Taking this stuff, once daily, WITH A MEAL is apparently better than doing a daily dose of warfarin.

I don't know the price of this new miracle anticoagulant, but I'll bet it's a bit more than the dime (or so) a day warfarin.

And, of course, they warn that one of the potential side effects is uncontrollable bleeding.

They make it clear that it's not for mechanical valves (not approved yet?).

Xarelto may, eventually, get approval for valvers (if they're even looking towards this use), but, for my money, warfarin seems to work okay, if monitoring is done in a timely manner (weekly is the right frequency, unless you have issues with unexpected highs or lows), doesn't really force life style changes, and is a hell of a lot less expensive than the new meds. The effects are also fairly rapidly reversible. This wasn't the case with Pradaxa. I don't know if it'll work with Xarelto.

I may post more when I know more about this new miracle drug that reduces trips to the 'clinic' from once a month (not enough, in my book) to quarterly.

 

[neo]

Xarelto

There are three new generation anti-coagulants on the market intended to compete with Coumadin. They are Pradaxa, Xarelto, and Eliquis. They're nice because you don't have to monitor INRs etc. They had raised hope for mechanical valve recipients as a viable alternative. Unfortunately, a recent study showed that one of them, Pradaxa, had failed in that regard. It remains to be seen what the other ones do, but Coumadin remains the only option for now.

http://www.forbes.com/sites/larryhu...th-boehringers-pradaxa-for-mechanical-valves/

 

[pellicle]

There are three new generation anti-coagulants on the market intended to compete with Coumadin. They are Pradaxa, Xaralto, and Eliquis. They're nice because you don't have to monitor INRs etc.

But they are also dangerous because clotting can not be restored in an emergency and often dialysis is required.

ey had raised hope for mechanical valve recipients as a viable alternative. Unfortunately, a recent study showed that one of them, Pradaxa, had failed in that regard.

Well only because people died...

 

[Protimenow]

I had a conversation a few years ago with a marketing manager at one of the meter makers, and he seemed to feel that there WOULD be a medication that displaces warfarin, and that the need for INR tests - and meters - would disappear. We're probably still a few years away from his 'prediction' coming to pass -- it doesn't look promising for any of the current anticoagulants. One thing that he probably didn't consider was cost -- If a person could safely anticoagulate for just a few dollars a month, would it really make sense to pay $250 for the privilege of not having to test? Would insurance companies (and government health care plans) permit the use of expensive drugs when a proven approach that costs nearly nothing, and has been successfully performing as expected, is already available?

It remains to be seen how big an impact more regulated health care costs will have on new drug development.

 

[neo]

Xarelto

Some of the best news for mechanical valvers seems to be with the ongoing PROACT trial conducted using the On-X mechanical valve. So far, seems to be good results. I believe there are different arms to the study, one with low dose Coumadin, one with Aspirin and Plavix instead.

http://finance.yahoo.com/news/x-heart-valve-study-results-154800753.html

 

[Protimenow]

This may be great news for future On-X users, and those with the right versions of On-X valves in their chests. I hope that the studies will show that all the On-X implantees will only have to take low dose aspirin (or something equally simple) to prevent clots for the rest of their long lives -- but this information won't be of much value to the 'pioneers' who have other valves (like most of us here).

But, of course, I'm just stating the obvious.

It WILL be great to have a low cost medication that prevents clots from forming on our older mechanical valves, has effects that are easily reversed, doesn't cost an arm and a let, doesn't require regular testing, and is readily available. However, it will be surprising if this happens in any of our lifetimes.

 

[Stopper]

Eliquis has the best data for A-Fib. It is the only newer agent that had less major bleeding than warfarin, 31% RRR, was superior to warfarin in reducing stroke and embolism, and the only newer drug that was superior to warfarin in all cause mortality Preety impressive. Like Xarelto it is a Factor Xa inhibitor, and they both have not been studied in mechanical valves. Pradaxa is a direct thrombin inhibitor, and their study in mechanical valves was a failure. There is a lot of hope that the Factor Xa inhibitors will be great for mechanical valves, but neither company is investing in a valve study. It appears to be up to the valve manufacturers to conduct a trial. They just completed phase 2 clinical trials for a reversal agent for Eliquis, and will probably have that in the next couple years. Also another important distinction is the quick onset of action compared to warfarin, no more bridging.

 

[Protimenow]

This certainly sounds promising. Thanks for the info.