There are other drugs that are better than pradaxa, and it has just been approved for limited indication. Let's wait and see what the post market approval results are like before we all jump off the coumadin bandwagon... pradaxa has several problems in certain populations, particularly those at risk of surgical complications, because it's not immediately reversible like coumadin or heparin. As mentioned, the cost and expiration are other considerations (and not insignificant ones - drugs don't work if patients can't afford to take them, no matter how good they are).
I haven't worked in a coumadin clinic but I do have to adjust dosing regularly in my patients, it's very interesting to see how patient-specific the doses and dose changes are. The job has a LOT of patient education required with regard to medication as well as diet, recognizing problems, when to call in etc.
I think the patients that require a/c longterm will still be managed by the a/c clinic, even if they are switched to a newer med. It is exciting to see the new drugs finally reaching market approval status. It's a good bet for the pharm company - lifelong treatment of a gazillion people with a/coagulation.. $$$