18. “My last cardiologist had me on the anticoagulant Pradaxa. My new cardiologist wants me to switch to Eliquis. Is Eliquis easier to deal with if bleeding occurs?”
There have been horrendous stories of people on Pradaxa (dabigatran) bleeding to death in the ER even from minor cuts while the ER doctors and staff can only watch as they die. Unlike for warfarin, there is no reversal agent or antidote for Pradaxa. The other NOACs, Eliquis and Xarelto, also don’t have reversal agents. But anecdotally they don’t seem to have as many bleeding deaths associated with them.
Added October 26, 2015: The FDA granted “accelerated approval” to Praxbind®, a reversal agent (antidote) to Pradaxa®. Praxbind is given intravenously to patients who have uncontrolled bleeding or require emergency surgery. In clinical trials, 5gs of Praxbind (idarucizumab) reversed the anticoagulant effect of Pradaxa within minutes (which is significantly faster than the current antidotes for warfarin).
Through an analysis of data from the ‘FDA Adverse Event Reporting System’ by AdverseEvents, Inc., Eliquis has received an “RxScore” safety score of 39.45 on a 100 point scale (1=lowest risk, 100=highest risk). In comparison, Coumadin (warfarin) had a score of 67.57. Pradaxa (dabigatran) had a score of 67.15, Xarelto (rivaroxaban) 67.08.
The FDA’s database comprises all the reports made by doctors, patients and other healthcare providers, which means it’s not a “scientific” finding with the authority of a clinical trial. AdverseEvents applies logic, math and software to the database to sift out the important data.
For Eliquis, “the rate of suspect cases was lower in every type of adverse-event report, from hospitalization to death.” For example, among Eliquis patients reporting side effects, only 21% cited hospitalization, while Pradaxa had 39%, Xarelto 43% and Coumadin (warfarin) 50%.
The results all point to the same general conclusion: Eliquis may be a safer choice among the new NOACs.
For more about the new anticoagulants, see Warfarin vs. Pradaxa and the Other New Anticoagulants.
Medical ID: If you’re on any blood thinner, it’s a good idea to carry some kind of medical ID. (See our Resources and Links for MedIDs free medical ID wallet card generator.) If you have an accident involving bleeding, EMTs don’t normally carry anticlotting meds. But they can call ahead to the ER and get the staff ready to help you.
Examining the Comparative Safety of Blood Thinners: An Analysis Utilizing AdverseEvents Explorer, February 2014, Special Report Download. http://info.adverseevents.com/special-report-blood-thinner Last accessed July 10, 2014.
Staton, Tracy. Eliquis earns best safety score in its class in analysis of FDA adverse event reports. FiercePharma, February 26, 2014. Last accessed July 10, 2014, http://www.fiercepharma.com/story/eliquis-earns-best-safety-score-its-class-analysis-fda-adverse-event-report/2014-02-26.
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