Among the antithrombotic agents used to eliminate thromboembolism in the veins after surgical interventions, Pradaxa is the most effective drug. Its analogs have wider indications for use and in their composition have different active components. Anticoagulants are available in solid dosage form with different dosages.
Description of the drug "Pradax"
The manufacturer of the Pradax antithrombotic and anticoagulant medication is Beringer Ingelheim Pharma GmbH and Co. KG ". The product is available in hard capsules, inside which contain small yellow granules. The active substance is dabigatran etexilate in an inactive form, the amount of which determines the dosage of the drug. It can be 75 mg, 110 mg and 150 mg.
Why use the drug "Pradax"
The main purpose of the capsules is associated with the prevention of venous thromboembolism after surgical interventions in the musculoskeletal system.
How does the tool "Pradax"
The mechanism of action of the Pradaxa drug is associated with the suppression of thrombin activity. Analogs have slightly different properties. Being a low molecular weight compound, dabigatran etexilate has no pharmacological effect.
Only after entering the human body, this substance after hydrolysis is split into free dabigatran, which is an active competitive reversible direct inhibitor of thrombin enzyme. The role of thrombin is to bind fibrin, thrombin, reduce platelet aggregation caused by thrombin activity.
Similar means
The drug "Pradax" has analogues. But in their composition they do not contain dabigatran etexilate, it is replaced by other anticoagulant substances. So, warfarin serves as an active component of a similar “Warfarin” drug, and rivaroxaban is contained in the “Xarelto” medication. Synonyms of the drug "Pradax" under the name "Markumar" and "Phenylin" include fenprokumon and fenindion respectively.
Description of the drug "Warfarin"
We have already listed what analogues of the Pradax medication have. Let us now consider in more detail one of them.
The medicine "Warfarin" is released in the form of tablets with a dosage of the active ingredient of 2.5 mg. The manufacturer of the drug is the Russian company Canonfarm Production.
There are other dosages (1 mg, 2 mg, 3 mg and 5 mg) of foreign drugs based on warfarin. The shape, color and size of the tablets are different, on one side the dosage in mg is applied.
What is the drug used for?
Reception "Warfarin" is possible:
- with venous thrombosis or predisposition;
- for the prophylactic treatment of thrombosis and thromboembolism;
- in acute course of vein thrombosis and thromboembolism in the lung tissue;
- with postoperative thrombosis;
- in acute heart muscle infarction;
- during surgical and thrombolytic therapy of thrombosis;
- with a transient attack of ischemic disease;
- for long-term treatment of recurrent venous thrombosis;
- during valve replacement in the heart.
How does the remedy work?
The special elements of Warfarin reduce blood coagulation, inhibit the production of factors (X, IX, VII, II) that are dependent on vitamin K and cause blood coagulation. Anticoagulant hepatic proteins S and C are synthesized to a lesser extent under the influence of the drug. All this reduces the formation of blood clots, leading to the formation of blood clots.
To eliminate venous thrombosis, doctors prescribe treatment with indirect anticoagulants. This prevents the development of repeated thrombosis, which can cause complications.
Calculation of the dose of warfarin with different INR indicators
The appointment of the drug "Warfarin" is possible after a detailed examination, during which all contraindications are identified. Based on the results of the analysis, the right amount of the Warfarin medication is selected for further treatment. The dose per day should not exceed 5 mg of the main active substance. With insufficient therapeutic effect, correction of the treatment is carried out. It is recommended to record the doses taken, the INR level and the resulting effects for analysis of therapy.
By INR (International Normalized Ratio) is meant the standard for determining the coagulation activity of blood elements. Coagulation factors affect the value of the indicator. It is important to control INR when taking "Warfarin", the rationing of which is inversely proportional to blood coagulation. Thus, at high values of the normalized ratio, coagulation slows down and hypocoagulation increases.
Under different conditions, certain INR values should be monitored.
- For a healthy body, its norm is approximately 1.0 (or deviates slightly - from 0.85 to 1.25).
- Chronic atrial fibrillation when taking Warfarin tablets should be accompanied by a normalized ratio of 2.0 to 3.0 units.
- The mechanical valve prosthesis is characterized by INR from 2.0 to 3.0, the mechanical mitral valve prosthesis from 2.5 to 3.5.
- In the treatment of thromboembolism in the pulmonary artery and some heart defects, an indicator level of 2.0 to 3.0 is needed.
- To prevent deep vein thrombosis after surgery and for the treatment of venous thrombosis, values of 2.0-3.0 are adhered to.
The use of the drug "Warfarin" should be carried out with careful monitoring of the INR indicator and the strict supervision of a doctor so that dosing can be regulated. Stabilization of the normalized relationship and the selection of the required amount of medication is carried out in about one week, and then this value is checked every 4 weeks.
To achieve the effect of the use of the drug "Warfarin", how to take it, how to drink it and whether it is possible to combine with food, you need to know. Tablets are drunk twice a day, not combining with the use of food. They are washed down with water and taken at one time. In addition, the test for INR should be at the same time and in a permanent laboratory. When skipping a dose, you need to take the next portion on time.
With INR values less than 2.0, thick blood is considered, the drug is ineffective, which means that you need to use a higher dosage of Warfarin.
With INR values greater than 3.0, blood is considered to be liquid, bleeding may occur, therefore, a lower dosage should be used.
The price of the drug "Warfarin"
Compared to the German drug Pradax, its Russian counterpart Warfarin, the price of which is from 80 rubles per package, is much cheaper and more affordable.
Description of the drug "Xarelto"
In the medicine "Pradax" analogues can be with the properties of anticoagulants that have a direct effect. The drug "Xarelto" belongs to them. It is produced in the form of round tablets in a film shell by the German company Bayer.
The composition contains rivaroxaban in micronized form. Xarelto tablets are available in the following dosages: 2.5 mg, 10 mg, 15 mg and 20 mg each.
Mechanism of action
Rivaroxaban is classified as highly selective direct inhibitors of the X-factor, which have a high bioavailability after oral administration.
The coagulation cascade is formed due to the activation of factor X, which, thanks to the internal and external coagulation pathways, is converted to factor Xa. This component is involved in the formation of prothrombinase compounds, from the action of which prothrombin is converted into thrombin. All these processes form a fibrin thrombus and activate platelets. There is an “explosion” in which up to 1 thousand of these blood cells are synthesized due to a single X-factor molecule.
With the help of selective inhibitors that reduce the activity of the activator, the “thrombin explosion” is stopped. The action of rivaroxaban is aimed at changing the results of a specific or general laboratory analysis, with the help of which the state of the coagulation system is evaluated. The activity of the X-factor varies depending on the dose of the inhibitor, which is the drug "Xarelto" (15 mg tablets or other dosages).
What is being treated with this drug
The instructions describe the use of the medication for the prevention of mortality after cardiovascular diseases associated with heart muscle infarction and acute coronary syndrome. The medicine “Xarelto” received positive reviews for the effective combination treatment together with aspirin or with aspirin and thienopyridine.
How to take different doses of the drug
The drug is intended for internal use. Tablets of all dosages are taken with meals.
To eliminate acute coronary syndrome, it is recommended to take one 2.5 mg tablet twice a day. Together with the drug "Xarelto" (reviews indicate the effectiveness of using this combination), you can take acetylsalicylic acid in a daily dose of 75 to 100 mg, as well as a combination of aspirin and clopidogrel in an amount of 75 mg per day. Such therapy requires constant monitoring by a doctor to maintain equilibrium, the displacement of which to one side can cause ischemic problems or bleeding. Taking the drug is long and takes about one year, in some patients it reaches two years.
Tablets in a dosage of 10 mg of rivaroxaban are taken 1 time per day. The first drink after 6-9 hours the field of surgical intervention with effective hemostasis. The duration of treatment with such an amount of the drug is determined for each patient separately and depends on the risk of thromboembolism in the veins, the complexity and type of operation.
When replacing the hip joint, the period of taking the Xarelto medicine (10 mg tablets) lasts up to 5 weeks, and for prosthetics of the knee joint it takes 14 days.
If the patient forgot to drink one dose of rivaroxaban, it should be taken immediately, and the next day continue treatment with 1 tablet.
Higher dosages of 15 mg and 20 mg are also not taken on an empty stomach.
In order to prevent a stroke and systemic thromboembolism with non-valvular cardiac atrial fibrillation, 1 tablet is used at a dosage of 20 mg once a day.
In renal failure, when the half-life of creatinine is less than 30 ml per 1 minute, a dose of 15 mg is used once a day.
The duration of treatment depends on the presence of a threat of a stroke and systemic thromboembolism.
The maximum allowable daily dosage should not be more than 20 mg of rivaroxaban.
For thrombosis affecting the deep veins, an initial dose of 15 mg twice a day for the first three weeks is used to prevent the re-development of this disease and thromboembolism affecting the pulmonary artery. In the future, they switch to tablets of 20 mg of rivaroxaban once a day for longer treatment and to prevent a recurrence of thrombosis and pulmonary embolism.
Patients are not always able to swallow a whole tablet, especially a large one, then it can be crushed and mixed with clean water or liquid food before use. Immediately after taking the drug, the patient should eat.
It is also possible the introduction of a crushed tablet with a gastric tube, the position of which in the digestive system is agreed in advance with the treating doctor. The rules for making a crushed tablet in this way are to mix the medicine with a small amount of water and then administer it. After this, a little more liquid is poured to remove residual drug from the probe. Following the medication, an enteral meal is necessary.
The price of the drug "Xarelto"
This tool refers to imported drugs with a high cost. For example, the drug "Xarelto" the price of the smallest dose will be for 56 tablets about 950 rubles. This is much more expensive than its Russian counterpart - the medicine "Warfarin". For Xarelto, the price increases depending on the increase in dosage. So, the cost of 14 tablets of 15 mg of rivaroxaban will be approximately 850 rubles, and for the packaging (28 pieces of tablets) with the highest dosage (20 mg of the main active substance) you will have to pay from 1450 rubles.