Pradaxa

I just recently heard about it, and haven't seen any patients on it yet.

I'm on a Tele floor and suddenly I am seeing it constantly in my AFib patients.

Same here.

Pradaxa is used selectively in our SNF, since it cannot be crushed or even taken out its capsule. (The potency can increase significantly if taken out of its capsule.) Therefore, we can only use it with patients that are able to swallow the capsule whole. Here's a link to a "Do Not Crush" List..you'll find Pradaxa there.

http://www.ismp.org/Tools/default.asp

I met the pradaxa rep in our area recently. This is per the rep. They are expecting pradaxa to be a blockbuster drug. It is already showing signs of it. The cost does not appear to be a problem in some areas. The patients are willing to pay it if one factors the cost of gas to go get bloodwork. With gas prices bumping up against 4.00 the rural patients cannot drive to get their bloodwork done. Also some insurance companies (again per the rep) are willing to pay it to avoid the expense of lab costs. It will be interesting to see how this plays out.

Pradaxa can not be reversed with FFP or anything. If your pt has a head bleed or GIB you can't take them to surgery. No thanks.

With gas prices bumping up against 4.00 the rural patients cannot drive to get their bloodwork done.

I had honestly never thought about this. Did you come up with this or hear it from the drug rep? Now, if the drug rep said it, it is to gain support for his drug. Either way, this is still a true barrier to care.

If the bleeding is acute, factor VIIa could be used.

Is that indeed true? One of our ER doctors (a very good, smart doctor might I add) was talking with a resident about Pradaxa. He expressed concerns that there was no reversal agent...he made it seem like there was absolutely no way to reverse therapeutic effects. If thats the case, then supportive care (IVF, RBCs, etc) are not going to cut it on a head bleed or someone who needs surgery now.

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

If I am not mistaken, right now it is only approved for preventing clots caused by A fib...not yet for other clotting disorders.

I had a patient transfered to me from the ICU who had previously (before hospitalization) been on it. One of the benefits is it doesn't require monthly lab work, but the bleeding risk is very high and dangerous. The patient lost a lot of blood from a pyluric ulcer and it seemed that the pradaxa was to blame for him almost not making it. He was very happy to be off the med.

My ICU has had 6 SEVERE GI bleeders due to this drug in the past few months. They bleed for days with nothing to reverse the medication effects. We just pour in blood as they pour it back out from usually multiple areas. Of course they are not surgical candidates, and IR is risky as well. Our staff is not impressed at all with this drug.

I just started on a neuro floor a few months ago. One of my very first patients was a 53yo female that had a massive hemorrhagic stroke, after being on Pradaxa. Floated to another floor a couple weeks ago & had a woman that ended up with a GI bleed as a result of it. Haven't had any other patients on it.

It scares me that there's no easy antidote.