Question

Please explain why the Health Care Provider would prescribe Warfarin instead of Dabigatran or Rivaroxaban to a patient who was recently diagnosed with Paroxsymal Atrial Fibrillation. The patient states " I don't want to take rat poison".How should the Provider respond ? For complete credit please list the risks and benefits to each drug.

Answer 1

Paroxysmal Atrial Fibrillation:

Atrial Fibrillation is a cardiac arrhythmia that involves the two upper chambers, atria, of the heart. Paroxysmal Atrial Fibrillation is the sudden occurance of atrial fibrillation . Even though it is not a life threatening condition in itself , it may have serious effects on heart. In this due to abnormal electric conduction, hear beat is not regular. Patients with Atrial Fibrillation are in high risk of developing Cardio- embolic stroke. Anticogulant drugs are used in the treatment of Atrial Fibrillation to prevent the formation of clot and resultant stroke .

Dabigatran: It is an Anticoagulant, used to prevent blood coagulation or clots and stroke. its trade name is Pradaxa. It is used in Atrial Fibrillation to prevent stroke and in people, who are in risk of developing clots like surgical patients eg: Hip replacement.

Rivaroxaban: Its brand name is xarelto. It is also an Anticoagulant medication, used to prevent and treat blood clots. It is mainly used in conditions like Atrial Fibrillation, pulmonary embolism, deep vein thrombosis and in Hip or knee replacement surgery to prevent clots.

Warfarin: It is an Anticoagulant medications that is used for the prophylaxis of thrombosis and embolism in many disorders . It is used in the treatment of Atrial Fibrillation, pulmonary embolism, deep vein thrombosis etc. Also used in artificial valve replacement surgeries, valvular heart disease etc.

" I don't want to rat poison " :

In the above case scenario, patient tells this dialogue. Because , there is a rat poison, that contains a high and lethal dose of drug warfarin, that bleeds the ra into death. Many experiments in the 1950s proved the effective use of Warfarin in humans to prevent clots.

Provider Response:

Provider can clarify to the patient regarding Warfarin by educating him. Tell him that

" I respect your autonomy to reject a drug, but same time I want you to understand about the difference between Warfarin, dabigatran and Revaroxaban."

Healthcare provider can explain the benefits of each drug ( as mentioned above).Also he can explain the risk associated with each drug.

Dabigatran : May cause bleeding as it is a blood thinner. In addition to that it may have side effects such as, indigestion, stomach pain and burning sensation. Patient , who use dabigatran may have increased risk of Gastrointestinal bleeding.

Revroxaban: may have a bad side effect of blood in urine and black , tarry stools due to GI bleeding. Nose bleeds, coughing up blood, vomiting of blood , bleeding gums, tiredness are the main other side effects of this drug.

It is a high alert medication as it possess a high risk of bleeding if it not taken as indicated.

Recent studies show that risk of death related to bleeding and stroke are more associated with Revaroxaban and dabigatran than they thought . Warfain also has side effects of  Gi bleeding, head ache, joint pain etc., but if the patient is maintaining correct dosage regimen and instructions as per Doctor's order, warfarin will be safe as it prevents platelet aggregation in A fib patients.

If a patient have mitral valve stenosis or any other valvular problem ,then Warfarin is indicated as a safer drug.

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