The Old and the New: Warfarin and Dabigatran February 4, 2010

 Is there anything better than Coumadin (warfarin) to prevent the atrial fibrillation strokes?

I cannot think of a medicine that is more detested by patients, nurses, and physicians than Coumadin (warfarin). I wish I had a dollar for every time a patient tells me “I don’t want to take ‘rat poison’.”

Yes, this medication has been used in rat poison. The rats are given a massive dose of the drug which causes internal bleeding. However, in humans if the medicine is properly monitored and dosed it can be life-saving by preventing most of the strokes caused by atrial fibrillation.

For the last 50 years we have not had any better oral blood thinners than Coumadin (warfarin). Fortunately, this will hopefully change in 2010!

This year we expect FDA approval of a new blood thinner, dabigatran, for atrial fibrillation. Dabigatran is one of several new blood thinners that we hope will soon be approved.

 In a large clinical trial, dabigatran was shown to be as good at preventing strokes as Coumadin (warfarin). The clear advantage of dabigatran is that it does not require frequent monitoring and there are not all of the food interactions, so patients can again eat their “green leafy vegetables.” The only downside I can see at this point is that it will definitely cost much more than Coumadin (warfarin).