Is there any new po anticoagulant that doesn't need frequent INR check?

blondy2061h, MSN, RN · Sep 10, 2011

I love the dry wit statement of a doc I work with ...
"Pradaxa is a great drug. Unless you have a head bleed, then it's a very bad drug."

Meanwhile Warfarin is more likely to cause that head bleed when your INR reaches 8 because they upped your dose last week when really the only issue was unwittingly eating a bit more K than usual.

I predict Pradaxa will take off, especially once costs come down a bit. If there's one thing to be said for Warfarin, it's that it's dirt cheap.

OhioCCRN, MSN, NP · Sep 10, 2011

My resident had an INR of 7, i gave Vitamin K, the next lab was 7.2... hmmm

Its interesting to know there are other ways to prevent clots.... (yup, you don't learn it all in NS)

Amanda.RN · Sep 10, 2011

I have several patients on Pradaxa & they've been doing really well on it. And not having to have blood work all the time is an excellent bonus. It's not good for patients who have a history of being non-complaint with their Coumadin though, because there's no way to "catch them" with subtherapeutic labs like you can do with Coumadin and INR monitoring. For this reason, it's really important that physicians are selective about which patients they put on this medication.

xtxrn, ASN, RN · Sep 10, 2011

My resident had an INR of 7 i gave Vitamin K, the next lab was 7.2[/u']... hmmm

Its interesting to know there are other ways to prevent clots.... (yup, you don't learn it all in NS)

I was told that it takes a few days for the dose to "react" to the changes made. There may have been carry over from the previous dose, that the vit K didn't have the 1/2 life to cover :)

It took me forever to get on a therapeutic dose (was getting 20mg/day for days before I got up to the required 2.5 --the hospital had a 2.5-3.5 range; other doc wanted 2.0-3.0). I was inpatient for 17 days w/PEs in all 3 lobes of my right lung, and R pulm. artery-enough to put pressure on the apex of my heart, and have t-wave changes....I finally got it therapeutic and then ended up on antibiotics about 4-5 times in the year before starting chemo. THAT really loused things up (and initially I didn't take it because my platelets were 7.0) After 4 months of attempting to get the INR up again, my hem/onc changed me over to Pradaxa. It's been SO nice to not have to get the bloodwork.

I've been a bit skittish about not having the lab numbers to make sure I'm not too thinned out- but since it acts totally differently (fibrinogen vs. thrombin) I just keep an eye on any subtle bleeding. I did have significant hematuria on Coumadin (another hospital stay). So far, after 3-4 months of the Pradaxa, it's been great. There haven't been any side effects to speak of (the nausea I've got on and off is more likely the chemo), which has also been nice. And if/when I need antibiotics I don't have to worry about popping a cork in my brain if I'm coughing :)

It's also been nice to have sushi (w/nori) or dark leafy lettuce salads whenever I want- and not have to worry about the vit K effects.

Overall, I've been lucky (first for surviving the PEs). :)

highlandlass1592, BSN, RN · Sep 11, 2011

I was told that it takes a few days for the dose to "react" to the changes made. There may have been carry over from the previous dose, that the vit K didn't have the 1/2 life to cover :)
It took me forever to get on a therapeutic dose (was getting 20mg/day for days before I got up to the required 2.5 --the hospital had a 2.5-3.5 range; other doc wanted 2.0-3.0). I was inpatient for 17 days w/PEs in all 3 lobes of my right lung, and R pulm. artery-enough to put pressure on the apex of my heart, and have t-wave changes....I finally got it therapeutic and then ended up on antibiotics about 4-5 times in the year before starting chemo. THAT really loused things up (and initially I didn't take it because my platelets were 7.0) After 4 months of attempting to get the INR up again, my hem/onc changed me over to Pradaxa. It's been SO nice to not have to get the bloodwork.
I've been a bit skittish about not having the lab numbers to make sure I'm not too thinned out- but since it acts totally differently (fibrinogen vs. thrombin) I just keep an eye on any subtle bleeding. I did have significant hematuria on Coumadin (another hospital stay). So far, after 3-4 months of the Pradaxa, it's been great. There haven't been any side effects to speak of (the nausea I've got on and off is more likely the chemo), which has also been nice. And if/when I need antibiotics I don't have to worry about popping a cork in my brain if I'm coughing :)
It's also been nice to have sushi (w/nori) or dark leafy lettuce salads whenever I want- and not have to worry about the vit K effects.
Overall, I've been lucky (first for surviving the PEs). :)

Kudos for things working well for you.....didn't want to do a regular kudo thinking I was happy you had been ill! And thx for sharing