When a loved one falls ill, you want to do everything to help him. Including finding a miracle cure that can cure him in an instant. Unfortunately, such pills have not yet been invented, and one has to be content with a fairly extensive arsenal of conventional medicines that have been created to date. Very many substances are, as it were, on the verge, when their useful action can turn into a mortal danger. These drugs also 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 the localization, can be fatal. Such are the drugs "Pradax" and "Warfarin", side effects from the use of which can manifest as hemorrhagic disorders.
Pradaxa pharmacological group
This drug belongs to the group of anticoagulants. Its active ingredient, dabigatran etexilate, is a low molecular weight, pharmacologically inactive precursor of dabigatran, a competitive, reversible direct thrombin inhibitor.manifesting its influence mainly in the blood plasma. Inhibition of thrombin activity prevents the process of thrombus formation. In addition to a direct effect on the blood coagulation factor, the active substance of the Pradaxa drug, the reviews of doctors on the action of which characterize it as a modern and effective drug, affects both fibrin clots and platelet aggregation.
Indications for use
This pharmacological group of drugs, which affects the body in the most serious way, requires very careful handling and strict adherence to the 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 the rate of cardiovascular mortality in people suffering from atrial fibrillation. Patients who have experience with the use of Pradaxa leave mostly positive reviews, since its appointment involves a much smaller number of side effects compared to older generation drugs.
Contraindications for use
As already mentioned, drugs from this group have a serious effect on the body, so they are prescribed only for very strict indications.
Pradax tablets are not used for:
- hypersensitivity to substances such as dabigatran, abigatranetexilate or to the 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 disorder;
- organ damage as a result of significant bleeding, including hemorrhagic stroke within 6 months prior to treatment;
- simultaneous appointment of "Ketoconazole" for systemic use;
- Liver dysfunction or disease affecting survival;
- the patient's age is under 18 (since there are no data from clinical studies).
Despite a significant list of contraindications for Pradaxa, doctors' reviews still characterize it as safer than some of its analogues.
Method of application and dosage
This drug, manufactured by Boehringer Ingelheim in Austria and Germany, is available in capsules containing 75 mg, 110 mg and 150 mg of active ingredient. Capsules are taken orally without opening, regardless of the meal. Multiplicity of reception - up to 2 times a day.
For the prevention of venous thromboembolism in patients undergoing orthopedic surgery, Pradaxa 110 mg is prescribed once, two capsules each. Patients after knee arthroplasty are advised to start taking the medication no later than 4 hours after the end of the operation. The course of treatment is 10 days. Athip arthroplasty, the drug should be continued for up to 28-35 days.
For the prevention of ischemic stroke in patients with non-valvular atrial fibrillation, a dosage of 150 mg 2 times a day of Pradaxa is prescribed, reviews of the use of which indicate a good percentage of prevented pathological conditions.
Anticoagulants, preventing the formation of blood clots, cause a decrease in blood clotting, which causes a general manifestation of undesirable effects. From the lymphatic and circulatory systems, thrombocytopenia and anemia may occur. Disturbances in the immune system can manifest as a hypersensitivity reaction (urticaria, itching, rash, bronchospasm). Increased vascular permeability can cause hematomas, bleeding of various locations, including intracranial, nasal, gastrointestinal, and others. On the part of the digestive organs, pain, dyspepsia, vomiting, dysphagia, gastroesophagitis, liver dysfunction and other abnormalities in the gastrointestinal tract can occur. On the part of the skin, manifestations of skin hemorrhagic syndrome can be observed, and damage to the connective and bone tissue can manifest as hemarthrosis.
Pradax drug. Analogues. Price
As mentioned above, this drug belongs to the group of anticoagulants, so substances of the same group can replace it. When choosing a suitable medicine, one must be clearly aware that one cannot be guided by criteria such as: “thischeaper” or “it helped a neighbor a lot.” Anticoagulants are very serious substances that systemically affect the entire body, therefore, only a doctor can prescribe both the dosage and the analogue of Pradaxa.
There are no substitutes for this drug in terms of the structure of the active substance. According to the pharmacological group, the drugs "Warfarin", "Marcumar", "Fenilin" 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 medicine slightly depends on the content of the active substance. For Pradaxa 110 or Pradaxa 150, the price will differ quite a bit.
The drug "Warfarin"
This substance is the oldest of the above anticoagulants. Its use requires careful adherence to the dosage and monitoring of the state of the blood, since exceeding the dose is very dangerous - the drug "Warfarin" becomes a poison. It is used for the treatment and prevention of thrombosis and embolism of blood vessels. Including prescribed for acute and recurrent venous thrombosis, pulmonary embolism, transient ischemic attacks and strokes, as well as for the secondary prevention of myocardial infarction and associated thromboembolic complications. The drug is also used to prevent thromboembolic complications in patients with atrial fibrillation, heart valve disease 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 in case of hypersensitivity to the constituent components of the drug, in case of acute bleeding, pregnancy (especially during the first trimester and in the last 4 weeks), as it has a teratogenic effect on the fetus, severe kidney disease and liver, acute DIC, deficiency of C and S proteins, thrombocytopenia. Also, do not prescribe it to patients who are expected to develop bleeding (including hemorrhagic disorders), suffering from esophageal varicose veins, arterial aneurysms, gastric or duodenal ulcers, bacterial endocarditis, malignant hypertension. Do not use in patients who have developed a hemorrhagic stroke or intracranial hemorrhage, with severe wounds (including surgical ones), before a lumbar puncture.
Anticoagulants, preventing excessive clotting, can sometimes have a negative effect on the body, causing increased bleeding. The drug "Warfarin" also has such an effect. Side effects are reduced mainly to bleeding of various localization. In addition, digestive disorders may occur.
Diet while taking Warfarin
The effectiveness of this product depends on the content of vitamin K. It enters the body with some foods, especially leafy greens. But you do not need to dramatically increase or decrease the proportion of these vegetables in the diet. Starting receptionmedications, you should not make changes to the usual menu or take vitamins or supplements without agreeing this with your doctor. When the dose of the drug is selected and already settled, a sharp increase in the consumption of foods rich in vitamin K 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, lettuce. The abrupt introduction of these products into the diet can lead to a weakening of the effect of the drug, and regular consumption of berries or cranberry juice, on the contrary, can lead to an increase in its effectiveness. Alcohol intake is absolutely unacceptable. That is, the diet while taking "Warfarin" is a prerequisite for successful and safe treatment.
Modern analogues of the drug "Warfarin"
At the moment, a number of drugs are being produced that can replace this medication, but have a much smaller number of side effects, including those that do not require constant monitoring of INR (an indicator characterizing blood clotting). Substitutes for the drug Warfarin, the use of which is due to the need to reduce the risk of thrombosis in the postoperative period, include the drugs Warfarex, Marevan, as well as Pradaxa and Xarelto, which have a similar mechanism of action and indications for use.
The drug "Varfarex" in the form of tablets, which has warfarin sodium clarate as the active ingredient. It is used in diseases such as pulmonary embolism, deep vein thrombosis, heart attack, as well as in surgery forprosthetic heart valves.
"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.
Pradaksa is an anticoagulant that is a direct inhibitor of thrombin, binding which prevents the formation of blood clots. It is prescribed for the treatment and prevention of thrombosis of the extremities, for the prevention of strokes, systemic thromboembolism and to reduce the risk of complications in atrial fibrillation.
Xarelto (rivaroxaban) is used as a prophylactic for thromboembolism after any orthopedic interventions on the lower extremities.
Drug "Xarelto". Features of appointment
These film-coated tablets contain micronized rivaroxaban as an active ingredient, which acts as a direct anticoagulant. It is a direct inhibitor of factor Xa (blood clotting factor, which is an activator of prothrombin), helping to suppress the formation of new thrombin molecules, but without affecting those already in the bloodstream. Prescribed for preventiondevelopment of venous thromboembolism in patients in the postoperative period after extensive orthopedic interventions.
You can not use the drug "Xarelto" - an analogue of "Pradaksa" - with hypersensitivity to rivaroxaban and other components of the 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. The use of the drug by patients suffering from severe renal insufficiency or having hereditary intolerance to galactose or lactose is not recommended. With caution, Xarelto tablets are prescribed 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, with a recent case of intracranial or intracerebral hemorrhage, with any pathologies of the vessels of the brain or spinal cord, with a recent operation on the spinal cord, brain or eyes. It is not recommended to use the medicine for people using systemic antifungal agents belonging to the azole group (for example, the drug "Ketoconazole") or receiving HIV protease inhibitors, as these substances increase the content of rivaroxaban (the active ingredient of the tablets) in the blood plasma, which increases the risk of bleeding.
Xarelto drug. Dosage and side effects
Pills 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 "Pradaksa", so the negative consequences after taking them are similar. The risk of overt or covert bleeding from any tissues and organs may increase, leading to posthemorrhagic anemia. These complications can manifest as weakness, dizziness, pallor, headaches, and shortness of breath.
Which drug do you prefer: Warfarin, Pradaxa or Xarelto?
You must clearly understand that systemic anticoagulants cannot be selected independently, the appropriate medicine, its dose and regimen are prescribed exclusively by a doctor. And these recommendations must be followed strictly. The information provided is for informational purposes only and cannot be a guide to action.
As the main advantage of Pradaxa and Xarelto drugs, such a moment is noted that their use does not require INR control and causes side effects much less frequently. But they can only be prescribed for non-valvular heart disease. Rheumatic valve disease or replacement with artificial valves involves the use of Warfarin exclusively.
The advantage of Xarelto over othersis that it is taken only once a day, and, according to some studies, it does not injure the organs of the gastrointestinal tract so much. But the range of indications for its use is very narrow, and this remedy is suitable mainly for patients after a major operation on the extremities to prevent the development of thromboembolism. In addition, this analogue of Pradaxa is categorically not suitable for women during pregnancy (any time) 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 drug "Warfarin" has a much wider scope, including, it is the only drug that is prescribed for lesions of the heart valves of any etiology (rheumatic or replaced artificial), in this it has no analogues. It can also be used during pregnancy (only with a very strong need), except for the first trimester (because it has a teratogenic effect) and the last four weeks before delivery (may cause spontaneous bleeding). The cost of the drug may also seem attractive, which will fit in a couple of hundred rubles, while the price of Xarelto tablets or Pradax capsules is ten times higher. The disadvantage of "Warfarin" is a greater number of side effects and the need for constant monitoring of blood counts.
The drug "Pradaksa" has an extensive range ofindications for use, does not require monitoring of blood counts, much less likely to cause negative manifestations. Its use during pregnancy and lactation is not recommended, although it is not a contraindication, as studies on its effects in these categories have not been conducted. Experiments on animals have not revealed a negative effect.
Thus, comparing the analogues of the drug "Pradaksa", we can conclude that when choosing any of them, you need to take into account a significant number of criteria. All medicines have their own characteristics in the application, and each specific case must be considered separately. Therefore, only a doctor can prescribe adequate and safe treatment (the use of Warfarin, Xarelto or Pradaxa).
