Strokes, and Blood Thinners: Some numbers, treatments, risks, and costs

           About 795,000  suffer a stroke in the U.S. every year. That is one person suffering a stroke every 40 seconds. Someone dies every 4 minutes from the U.S. See this link here from the American Heart association and the American Heart Association.

           Blood clots can cause heart attacks and strokes. Strokes and heart attacks, specifically in the elderly population, can cause severe debilitating long term effects including paralysis and even death. Blood thinners have lowered the risk of strokes and heart attacks and all of their debilitating side effects  by reducing the formation of  blood clots in the body.  In order to reduce the risk of blood clots for vulnerable patients (e.g. older people or people with a history of blood clots), doctors prescribe anti-coagulant drugs.    Anti-coagulant drugs reduce the risk of blood clots that can lead to heart attacks and strokes by decreasing the clotting ability of blood. However, as a necessary consequence of reducing the clotting ability of blood, anti-coagulant drugs increase the risk of excessive bleeding.  

         The leading anti-coagulant drug for decades was Warfarin, also known as Coumadin.  It works by inhibiting the production of vitamin K. The known antidote to stop bleeding while on Warfarin is the injection of vitamin k.

          Recently, the pharmaceutical industry has developed novel anti-coagulant drugs. Their scientific names are dabigatran, rivaraxaban, and apixaba  Their trade names are Pradaxa, Xarelto and Eliquis. 

One advantage of the novel anti-coagulants, as compared to Warfarin, is that there is a less severe risk of intracranial bleeding (AKA a brain hemorrhage).  A serious disadvantage, however, is that there is (or was) no known specific antidote for bleeding caused by the novel anti-coagulants.    The vitamin K method used to stop bleeding caused by Warfarin does not work for Pradaxa, Xarelto and Eliquis because those drugs do not work by inhibiting the production of vitamin K. Rather, they work by directly targeting an enzyme in the blood called Factor Xa, which stimulates the production of thrombin, another enzyme which promotes blood clot formation.  

Economically, Warfarin is estimated to cost about $200 annually compared to Xarelto which can cost close to $3,000 anually.

           In 2013, Pradaxa’s globals sales were about $1.63 billion USD.  Xarelto’s sales were $271 million USD. Eliquis’es sales were only $71 million USD but it only became available in the middle of the year.

           Many strokes are preventable. It is important to know your risk and weigh the cost and benefit of treatment. But it is also important to keep in mind the risk from the treatment. 

         I am short on time so I will continue this post later on....