By Richard J Weachter, MD

Dabigatran, aka Pradaxa, is a new “blood thinner” pill that decreases a person’s natural ability to form blood clots inside and on the surface of the body. In October of 2010, it was approved by the Food and Drug Administration (FDA) to prevent strokes in people with atrial fibrillation.

Atrial fibrillation is the most common sustained heart rhythm problem. More than 2 million Americans have it. As we grow older, our risk of developing atrial fibrillation increases. By the time we turn 40 years old, our chance of developing atrial fibrillation sometime later in life is about 25 percent.

People with atrial fibrillation can be unaware they have it or can have irregular beating of their heart along with shortness of breath and occasionally chest pain. But what doctors worry the most about is the risk of having a stroke from atrial fibrillation. Because the heart’s atria (top 2 pumping chambers of the heart) are not squeezing correctly, blood clots can form within them, break away, go to the brain and cause a stroke. People who are at high risk for this happening are frequently put on Warfarin (aka Coumadin), but now a new pill is available — Dabigatran (Pradaxa).

Patients taking Warfarin (Coumadin) frequently don’t like it. As expected, because it “thins the blood” it increases the risk for bleeding. But it has other inconveniences — it has to be stopped several days before dental work or surgery, requires frequent blood testing (at least once a month), and is affected by the food we eat and other medicines we take (which results in more blood testing). Patients on Warfarin must surely be nodding their heads in agreement!

Dabigatran (Pradaxa) has some potential advantages over Warfarin (Coumadin). While it can cause more bruising and bleeding like Warfarin, and will need to be stopped before surgery, it isn’t affected by nearly as many medicines or by the food we eat like Warfarin and doesn’t require any blood testing to know how much to take like Warfarin. However, it does have some potential disadvantages. Dabigatran has to be taken more often than Warfarin, can’t be taken if your kidney’s don’t work (unlike Warfarin), has no antidote to correct its “blood thinning” effect (unlike Warfarin) and, because it’s so new, is more expensive than Warfarin.

Now, people on Warfarin (Coumadin) for other reasons besides atrial fibrillation may be wondering if they can take Dabigatran (Pradaxa) instead. While medical studies are looking to see if Dabigatran can be used to treat people who have had leg vein blood clots, lung blood clots or who have mechanical artificial heart valves, these studies remain ongoing. For now, Dabigatran (unlike Warfarin), is not approved for treating these conditions in the USA but one day might be.

So, if you have atrial fibrillation, and your doctor believes you may be at risk for having a stroke from it, you may need to be on a “blood thinner” like the “tried and true” Warfarin (Coumadin) or the “ new kid on the block” Dabigatran (Pradaxa). 

Editor's note: This article is part of a special series brought to you by Missouri Medicine, the Medical Journal of the Missouri State Medical Association (MSMA). MedHelp, Missouri Medicine, and MSMA are collaborating to educate and empower health consumers by making the latest scientific studies and medical research available to the public. Learn more about MSMA and see more from Missouri Medicine.

This is a summary of the article "Dabigatran: A New Anticoagulant for Stroke Prevention in Patients with Atrial Fibrillation" by Richard Weachter, MD, which was originally published in the  issue of Missouri Medicine. The full article is available here.

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