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....
