Pradaxa

tamadrummer · Jun 5, 2011

I had a patient last quarter that had A-Fib with RVR that was on it. She was having good success but had to bring her own into the hospital because they did not have it as a medication. I am a nursing student so I have no clue if it is being used now or not but it seemed to be great. Her INR was right at 2 and she was not having any issues with her blood, she was having CHF when she came in.

Jenni811, RN · Jun 5, 2011

Wow...yea i've never had anyone on it yet. some of our physicians are kind of old "fuddy duds" and don't like to change their ways. With the exception of a couple who i'm surprised aren't already all over it.

Never had a patient on it. But i know Vit. K does not interfere with it (maybe making it a better option for vegetarians?). Is there an antidote then?? I've had to give SQ Vit. K twice for antidote to coumadin.

tamadrummer · Jun 5, 2011

http://www.theheart.org/article/1142899.do

According to this article, No there are no antidotes at the moment. It seems to be pretty silly to have such a dangerous medication without any way to stop it other than dialysis.

Hope this helps.

Jenni811, RN · Jun 5, 2011

"Yea sorry mr. smith your INR is too high your going to have to start dialysis"

..hm, i think i'll stick with coumadin until they come up with something better. Vitamin K sounds much more pleasing.

Flo., BSN, RN · Jun 5, 2011

It is also alot more expensive.

hopefulwhoop · Jun 5, 2011

I've had one pt on it. Coumadin is still the drug of choice at my hospital. And, yeah, pradaxa is very expensive...

lvICU · Jun 5, 2011

It sounds like it has potential to be a great alternative to coumadin. There is no routine monitoring required. That is a nice perk! And you wouldn't have to worry about all those crazy doses like "take 1 pill on M,W and F and a half pill on the other days."

Yes, there is no antidote but the half life is approximately 12 hours so stopping the medication while providing supportive care (IVF, blood products) would most likely control the bleeding. If the bleeding is acute, factor VIIa could be used.

SC_RNDude · Jun 5, 2011

I've seen it with maybe 6-8 pts in the last few months, all with Afib.

NurseKatie08, MSN · Jun 5, 2011

Funny it should be mentioned today, because I just admitted a patient on it to my rehab unit last night. New onset Afib, declined Coumadin d/t dislike of blood draws. Had heard of it before but this is my first time working with the med. Figured it must cost some major $$$ since it is so new. Sounds like it has the potential to be a good alternative, but scary the fact that there's little/no regular monitoring involved...guess I will develop opinions as I am exposed to it more.

MunoRN, RN · Jun 5, 2011

It's pricey- about $250-300 per month, but some medicare plans are now covering it, with a $50 monthly co-pay, which is still a lot of money for many patients. We have been using it some in the past couple of months, with the cardiology practice covering most of the cost, this is because we see some patients who lives hours from any clinic and in the past we have had to avoid coumadin use in the past, making Pradaxa worth the money.

nurseynursej · Jun 5, 2011

I've had about 3 or 4 patients using Pradaxa thus far in the SNF where I work. It does seem to be a great alternative to coumadin since there aren't blood draws and changing of dosing often. The only side effect I've dealt with is GI upset and that was only with one patient. I'm sure it will continue to be a great benefit to the geriatric population r/t decreased error dosing with the weekly changing of doses and the blood draws.