FAQ: Should I Switch From Coumadin to Pradaxa?

It depends. If you've been having difficulty managing your Coumadin (generic name warfarin) dosing, or if you and your doctor have been having trouble keeping your so-called INR (international normalized ratio, which is the blood test reading usually used to monitor and adjust Coumadin dosing) in the right range, you'll probably benefit from a switch to one of the newer anticoagulant medications.

That's because, although Coumadin is inexpensive and is the most commonly used anticoagulant, it interacts with many medications and foods. This means people can quickly find themselves with blood that's too thin or not thin enough, and hence they're at risk for blood clots or strokes. To avoid this, safe use of Coumadin requires constant monitoring and frequent dose adjustments.

However, in October 2010, the FDA approved the first of a new class of anticoagulants, Pradaxa (generic name dabigatran). A similar medication, Xarelto (generic name rivaroxaban), was approved in November 2011. Both these medications are effective anticoagulants but don't require monitoring of blood levels and don't interact as easily with foods and medications. For these reasons, many experts believe that the newer anticoagulants are a better choice for most people who need to take a chronic blood-thinning medication.

Of course, the newer medications have some disadvantages. They're much more expensive than Coumadin, so you'll want to check with your insurance company regarding the cost. We also don't yet know much about any long-term safety effects, whereas Coumadin's many disadvantages are at least well understood. And finally, should you ever be hospitalized for bleeding, there's currently no antidote for the newer anticoagulants, although one does exist to reverse the effects of Coumadin.

Bottom line: If you've had a stable INR on Coumadin and haven't found the monitoring too onerous, there's no compelling reason to switch. But if being on Coumadin has been a struggle for you, then a switch to a newer medication is probably reasonable, as long as you understand the disadvantages of the newer drugs.