Warfarin Institute of America

Pharmacotherapy 19(9):1013-1025, 1999. © 1999 Pharmacotherapy Publications

Dalteparin is used to treat or prevent harmful blood clots. Preventing harmful blood clots helps to reduce the risk of a stroke or heart attack. This medication helps keep your blood flowing smoothly by lowering the activity of clotting proteins in the blood. Dalteparin is a type of heparin, and works as an anticoagulant (commonly called a "blood thinner").

Obstetrics & Gynecology 2003;101:455-462 © 2003 by The American College of Obstetricians and Gynecologists

PRADAXA is a prescription blood-thinning medicine used to reduce the risk of stroke and blood clots in people with atrial fibrillation not caused by a heart valve problem. With atrial fibrillation, part of the heart does not beat the way it should. This can cause blood clots to form, increasing your risk of a stroke. PRADAXA lowers the chance of blood clots forming in your body.

After interviewing Craig Cole, MD, Hematologist at Gundersen Lutheran Medical Center.  I am surprised it was it was approved by the FDA.  While the marketing & prescribing information do not say much, the grey information is starting to come out and was discussed at the recent American Society of Hematologists (ASH) meeting, which the APSFA was invited to attend.  

You have been handed these shots. I know you are scared. But, I know you can do it. And with these extra tips it should make things go a little smoother for you.

XARELTO® is a prescription medicine used to: reduce the risk of stroke and blood clots in people with atrial fibrillation, not caused by a heart valve problem & reduce the risk of forming a blood clot in the legs and lungs of people who have just had knee or hip replacement surgery

Overdose of XARELTO may lead to hemorrhage. A specific antidote for rivaroxaban is not available. Rivaroxaban systemic exposure is not further increased at single doses >50 mg due to limited absorption. Discontinue XARELTO and initiate appropriate therapy if bleeding complications associated with overdosage occur. The use of activated charcoal to reduce absorption in case of XARELTO overdose may be considered. Due to the high plasma protein binding, rivaroxaban is not expected to be dialyzable.

December 7, 2011

Xarelto (Rivaroxaban) was approved in Europe today (Dec 19th, 2011) for patients with acute DVT. This is good news on the path to have a blood thinner for patients with DVT available that is easier to deal with than Warfarin. Xarelto is not approved at this point for DVT and PE in the U.S.

Written by: Tina Pohlman

Written by Tina Pohlman. Please see page 6. You have been handed these shots. I know you are scared. But, I know you can do it. And with these extra tips it should make things go a little smoother for you.

At this point I would consider switching a patient who has been on warfarin to Xarelto, 20 mg once daily, if he/she is not tolerating warfarin well, i.e. has fluctuating INRs, significant side effects from warfarin (hair loss, fatigue) or difficulty getting to an anticoagulation clinic and monitoring the INR . This would be off label use, meaning that the Xarelto DVT and PE data have not been reviewed by the FDA and that the drug is not FDA approved for the use in DVT and PE. There are also some other caveats that need to be discussed with the patient: (a) There is no reversal agent in case major bleeding occurs, (b) the drug is still relatively new, and (c) patients with significantly impaired kidney function should not use the drug. Certainly, a patient needs to discuss all these issues with his/her physician.

If you are considering to start therapy with the new oral “blood thinner” Xarelto® (Rivaroxaban), there are a few safety nets that your local hospital and physician may want to establish to make therapy as safe as possible for you. Issues to be addressed are (a) dosing, (b) management of major bleeding, (c) interruption of therapy for surgery, dental procedures, or other procedures, and d) what to do if you missed a dose.