When a loved one falls ill, I want to do everything to help him. Including to find a miracle remedy that can cure it in an instant. Unfortunately, such pills have not yet been invented, and you have to be content with a fairly extensive arsenal of conventional medicines created to date. Too many substances are on the verge of when their beneficial effects can turn into mortal danger. These drugs include the pharmacological group of anticoagulants, which, preventing the formation of blood clots, at some point contribute to the occurrence of spontaneous bleeding, which, depending on localization, can be fatal. Such are the medicines “Pradaxa” and “Warfarin”, side effects from the use of which can be manifested by hemorrhagic disorders.
Pharmacological group of the drug "Pradax"
This medicine belongs to the group of anticoagulants. Its active substance - dabigatran etexilate - is a low molecular weight, pharmacologically inactive precursor of dabigatran - a competitive, reversible direct thrombin inhibitor, which manifests its effect mainly in blood plasma. Inhibition of thrombin activity impedes the process of thrombosis. In addition to the direct effect on the coagulation factor , the active substance of the drug "Pradax", the doctors' reviews about the action of which characterize it as a modern and effective drug, has an effect on fibrin clots and platelet aggregation.
Indications for use
This pharmacological group of drugs that affects the body in the most serious way requires very careful handling and strict adherence to dosage. Only a doctor can prescribe such a remedy. This anticoagulant is used to prevent the occurrence of venous thromboembolism in patients with a history of any orthopedic surgery, as well as to prevent the development of stroke, systemic thromboembolism and to reduce cardiovascular mortality in people suffering from atrial fibrillation. Patients with experience in the use of the drug "Pradaxa" leave reviews mostly positive, since its purpose implies a much smaller number of side effects compared to old-generation drugs.
Contraindications
As already mentioned, drugs from this group have a serious effect on the body, therefore, they are prescribed only for very strict indications.
Pradax tablets are not used for:
- hypersensitivity to substances such as dabigatran ", abigatran etexilate or to auxiliary components included in the composition;
- severe renal failure (CC less than 30 ml / min);
- intense clinically significant bleeding, hemorrhagic diathesis, spontaneous or pharmacologically induced hemostasis;
- organ damage as a result of significant bleeding, including hemorrhagic stroke, within 6 months before treatment;
- the simultaneous appointment of "Ketoconazole" for systemic use;
- impaired function or liver disease affecting survival;
- the patient's age is up to 18 years (since there are no data from clinical studies).
Despite a significant list of contraindications for the drug “Pradaxa”, reviews of doctors nevertheless characterize it as safer compared to some of its analogues.
Dosage and administration
This medicine, manufactured by the Beringer Ingelheim company in Austria and Germany, is available in the form of capsules containing the active substance 75 mg, 110 mg and 150 mg. Capsules are taken orally without opening, regardless of food intake. Multiplicity of admission - up to 2 times a day.
For the prevention of venous thromboembolism in patients undergoing orthopedic surgery, the drug Pradaxa 110 mg is prescribed once in two capsules. Patients after knee arthroplasty are recommended to start taking the medicine no later than 4 hours after the end of the operation. The course of treatment is 10 days. With hip replacement, the drug should be continued for up to 28-35 days.
For the prevention of ischemic stroke in patients with non-valve atrial fibrillation, a dosage of 150 mg 2 times a day of the drug Pradax is prescribed, reviews of which indicate a good percentage of prevented pathological conditions.
Anticoagulants, preventing the formation of blood clots, cause a decrease in blood coagulability, which determine the general manifestation of undesirable effects. From the lymphatic and circulatory systems, thrombocytopenia and anemia can occur. Disorders in the immune system can manifest as a hypersensitivity reaction (urticaria, itching, rash, bronchospasm). Increased vascular permeability can cause hematomas, bleeding of various localization, including intracranial, nasal, gastrointestinal and others. From the digestive organs, pain, dyspepsia, vomiting, dysphagia, gastroesophagitis, liver dysfunction and other abnormalities of the gastrointestinal tract may occur. From the skin, you can observe the manifestations of skin hemorrhagic syndrome, and damage to the connective and bone tissue can manifest as hemarthrosis.
The drug "Pradax". Analogs Price
As mentioned above, this drug belongs to the group of anticoagulants, therefore, substances of the same group can replace it. When choosing the right medication, you need to be clearly aware that you can not be guided by criteria such as: "it is cheaper" or "it really helped a neighbor." Anticoagulants are very serious substances that systemically affect the entire body, therefore only the doctor can prescribe the dosage and the analogue of Pradaxa.
According to the structure of the active substance, there are no substitutes for this medicine. According to the pharmacological group, the drugs "Warfarin", "Markumar", "Phenilin" and "Xarelto" may be suitable.
The price of this drug is quite high. So, a package containing 60 capsules costs about 3 thousand rubles, 30 capsules will cost about 2 thousand rubles. The cost of the drug does not significantly depend on the content of the active substance. For Pradax 110 or Pradax 150, the price will differ slightly.
The drug "Warfarin"
This substance is the oldest of the above anticoagulants. Its use requires careful observance of the dosage and monitoring of the blood condition, since excess doses are very dangerous - the drug "Warfarin" in this case becomes a poison. Use it for the treatment and prevention of thrombosis and embolism of blood vessels. In particular, it is prescribed for acute and recurrent venous thrombosis, pulmonary artery embolism, transient ischemic attacks and strokes, as well as for the secondary prevention of myocardial infarction and its associated thromboembolic complications. The medicine is also used to prevent thromboembolic complications in patients with atrial fibrillation, damage to the heart valves or with prosthetic heart valves, as well as in the postoperative period after orthopedic interventions to reduce the risk of blood clots.
“Warfarin” tablets are not used for hypersensitivity to the components of the drug, for acute bleeding, pregnancy (especially during the first trimester and in the last 4 weeks), since it has teratogenic effects for the fetus, severe kidney and liver diseases, acute DIC syndrome, deficiency of C and S proteins, thrombocytopenia. Also, it is not prescribed to patients who are suspected of developing bleeding (including hemorrhagic disorders), suffering from varicose veins of the esophagus, aneurysm of the arteries, peptic ulcer of the stomach or duodenum, bacterial endocarditis, and malignant hypertension. Do not use in patients who have developed hemorrhagic stroke or intracranial hemorrhage, having severe wounds (including operating ones), before lumbar puncture.
Anticoagulants, preventing excessive coagulation, can sometimes have a negative effect on the body, causing increased bleeding. The drug "Warfarin" also has this effect. Side effects are reduced mainly to bleeding of various localization. In addition, digestive disorders may occur.
Diet when taking "Warfarin"
The effectiveness of this product depends on the content of vitamin K. It enters the body with certain products, especially with leafy greens. But you do not need to drastically increase or decrease the proportion of these vegetables in the diet. Starting taking the medicine, you should not make changes to the usual menu or take vitamins or dietary supplements without coordinating this with your doctor. When the dose of the drug is selected and already established, a sharp increase in the consumption of foods rich in vitamin K content can reduce its effectiveness and lead to increased thrombosis. The greatest amount of this vitamin is found in green tea, spinach, parsley, cabbage of different varieties, salad. A sharp introduction to the diet of these products can lead to a weakening effect of the drug, and regular consumption of berries or cranberry juice, on the contrary, can lead to an increase in its effectiveness. Drinking alcohol is absolutely unacceptable. That is, a diet when taking "Warfarin" is a prerequisite for a successful and safe treatment.
Modern analogues of the drug "Warfarin"
At the moment, a number of drugs are available that can replace this medication, but with a much smaller number of side effects, including those that do not require constant monitoring of INR (an indicator of blood coagulation). Warfarin substitutes, the use of which is determined by the need to reduce the risk of thrombosis in the postoperative period, include Warfarex, Marevan, as well as Pradax and Xarelto, which have a similar mechanism of action and indications for use.
The drug "Warfarex" in the form of tablets, having warfarin sodium clarate as the active substance. It is used for diseases such as pulmonary thromboembolism, deep vein thrombosis, heart attack, as well as for surgery on prosthetic heart valves.
The drug "Marevan" containing the same active substance prescribed for the following diseases: thrombosis, heart attack (including for the prevention of complications after a heart attack), valve replacement and other heart diseases, strokes and ischemic attacks (including for their prevention).
The above funds, differing only in the composition of excipients, exhibit all the characteristic properties of the basis, and also require similar precautions and control of INR.
The drug "Pradax" is an anticoagulant, which is a direct inhibitor of thrombin, binding which prevents the formation of blood clots. It is prescribed for the treatment and prevention of limb thrombosis , for the prevention of strokes, systemic thromboembolism and to reduce the risk of complications with atrial fibrillation.
The drug "Xarelto" (rivaroxaban) is used as a prophylactic for thromboembolism after any orthopedic interventions on the lower extremities.
The drug "Xarelto". Features of the appointment
These film-coated tablets contain micronized rivaroxaban as an active ingredient, which manifests its effect as a direct-acting anticoagulant. It is a direct inhibitor of factor Xa (coagulation factor, which is an activator of prothrombin), helping to suppress the formation of new thrombin molecules, but not affecting those already in the bloodstream. Assign it to prevent the development of venous thromboembolism in patients in the postoperative period after extensive orthopedic interventions.
You can not use the drug “Xarelto” - an analogue of “Pradaxa” - with increased sensitivity to rivaroxaban and other components of tablets, clinically significant active bleeding (for example, intracranial or gastrointestinal), liver diseases accompanied by coagulopathy, which significantly increases the risk of dangerous hemorrhages. Do not prescribe this medicine during pregnancy and breastfeeding, as well as children under 18 years of age. Use of the drug is not recommended for patients suffering from severe renal failure or who have hereditary intolerance to galactose or lactose. Xarelto tablets are prescribed with caution to patients who have an increased risk of bleeding of any etiology: with congenital or acquired bleeding, with severe arterial hypertension, with exacerbation of ulcerative lesions of the stomach and duodenum, in the recent case of intracranial or intracerebral hemorrhage, with any pathologies of the vessels of the brain or spinal cord, with recent surgery on the spinal cord, brain or eyes. It is not recommended to use the medicine for people who use systemic antifungal agents belonging to the azole group (for example, Ketoconazole) or receive HIV protease inhibitors, since these substances increase the content of rivaroxaban (the active ingredient of tablets) in the blood plasma, which increases the risk of bleeding .
The drug "Xarelto." Dosage and side effects
The tablets are taken orally, regardless of the meal, once a day (dose of 10 mg). As a prophylaxis of venous thromboembolism after extensive surgical interventions on the hip joint, treatment is continued for 5 weeks, on the knee joint - up to 2 weeks.
The drug "Xarelto" is an analogue of "Pradaxa", so the negative consequences after taking them are similar to each other. The risk of overt or covert bleeding from any tissues and organs, leading to posthemorrhagic anemia, may increase. Complications of this kind can be manifested by weakness, dizziness, pallor, headaches and shortness of breath.
Which drug to prefer: Warfarin, Pradaxa or Xarelto?
It must be clearly understood that systemic anticoagulants cannot be selected on their own, the appropriate medicine, its dose and regimen are prescribed exclusively by the doctor. And these recommendations must be adhered to strictly. The information provided is for guidance only and cannot be a guide to action.
As the main advantage of the drugs "Pradax" and "Xarelto" note such a moment that their use does not require INR control and much less likely to cause side effects. But they can only be prescribed with a non-valve form of heart disease. Rheumatic damage to the valves or their replacement with artificial ones involves the use of exclusively the drug "Warfarin".
The advantage of Xarelto over others is that it is taken only once a day, and it, according to some studies, does not so injure the organs of the gastrointestinal tract. But the range of indications for its use is very narrow, and this tool is suitable mainly for patients after major surgery on the extremities to prevent the development of thromboembolism. In addition, this analogue of “Pradaxa” is categorically not suitable for women during pregnancy (any period) and lactation, since the active substance easily penetrates the placenta, having a negative effect on the fetus, and also causing uterine bleeding, and is excreted in mother’s milk, therefore its appointment is possible only with the complete abolition of breastfeeding.
As already mentioned, the medicine "Warfarin" has a much wider scope, including the only drug that is prescribed for damage to heart valves of any etiology (rheumatic or replaced artificial), there are no analogues in this. It can also be used during pregnancy (only if very necessary), except for the first trimester (since it has a teratogenic effect) and the last four weeks before childbirth (can cause spontaneous bleeding). The cost of the drug, which will fit in a couple of hundred rubles, may also seem attractive, while for Xarelto tablets or Pradax capsules the price is ten times higher. «» .
«» , , . , , . .
, «», , - , . , . ( «», «» «») .