Caring Currents

Hail, Hail, Heart Patients: an Alternative to a Common Heart Medication

Last updated: Sep 02, 2009

90 degrees and Freezing

Say the name Coumadin (warfarin) to people with atrial fibrillation and those who care for them, and you'll get an earful. The side effects, complications, and long list of drug interaction problems associated with Coumadin make this a difficult drug to stay on long-term.

Just as an example, when I reported the story [10 medication mistakes that can kill] (, Coumadin/warfarin (people refer to it by both names, brand and generic) was one of the drugs mentioned most often.

Coumadin's interactions with other drugs are very serious, and the list of drugs with which Coumadin can have dangerous interactions is pages long. Aspirin, ibuprofen, and acetominophen are all on the list, making it difficult for those on Coumadin to get pain relief. Coumadin can interact with cold and allergy medications, antibiotics, birth control pills, and drugs for arrhythmia, such as amiodarone. It can also interact with many common supplements, including fish oil, gingko, ginseng, Vitamin K, coenzyme Q10, and even garlic.

Even on its own, Coumadin can cause problems. It can trigger bleeding problems, including intracranial hemorrhage, or bleeding between the brain and skull, which is very dangerous. Not to mention that it makes people taking it feel cold all the time!

So I was thrilled this week to read some positive news for heart patients: A new drug, dabigatran, was tested in trials and showed that it is just as effective as warfarin but without many of the problematic side effects.

Both drugs are anticoagulants that thin the blood, and as such, both are successful in preventing the blood clots that can cause strokes. But dabigatran was found to have less than one third the risk of intracranial hemorrhage as Coumadin. And the study, which tested two different doses of dabigatran, found that the higher dose, 150 mg, was more effective than Coumadin at preventing stroke.

The study was enormous, following 18,000 people in 44 countries, and experts were very excited about the dramatic results. But there's a problem: Dabigatran in still in clinical trials and not yet FDA-approved, so you can't just ask your doctor for a prescription. If you or someone you're caring for has atrial fibrillation and the doctor recommmends Coumadin, ask about the possibility of trying dabigatran instead; that may involve getting into a clinical trial. Dabigatran has already been approved in Canada, England, and Europe, and the British Heart Foundation is so impressed with dabigatran that it's campaigning for the drug, called Pradaxa in England and Pradax in Europe, to replace Coumadin as the standard of care.

There are a few downsides to dabigatran. It can cause heartburn in many of those who take it. And in the study there was a very small incidence of heart attack, which the researchers are still investigating. But the main problem is price. While we don't know yet what the cost of dabigatran will be in the U.S., it's likely to be much more expensive than warfarin, which is available as a generic. Experts are predicting that insurers will be reluctant to pay for it, at least at first, when warfarin is so much cheaper.

Either way, predictions are that things will move quickly now, with such impressive trial results, and soon those at risk for stroke will have a choice of drugs to choose from. Given the devil's bargain many patients are striking with Coumadin, that's a good thing.