Please note that in the 2 years since this video was posted, additional studies have been published which support the use of these drugs. I leave the video up because the issues discussed are still relevant. However, if you are a layperson, please do NOT stop taking your Xarelto or Pradaxa just because you watched this video. Instead, discuss your concerns with your physician. There is more than one alternative anticoagulant out there.
Thank you for this video. I am faced right now by my hematologist with a decision between continuing the Warfarin I've been on for 14 years or going on one of the newer drugs such as Eloquist. I am leaning toward staying with Warfarin. My concern is the fact that in an emergency case of internal bleeding or a need for emergency surgery there is no way to interfere with the Eloquist's effects of blood thinning. With Warfarin, my understanding is that there is an emergency intervention treatment that could possibly be implemented. It's a serious topic and a big decision. Thank you for your information and for updating with this comment.
This is a decision I may have to make in the next few weeks.I now their are reversal agents for all no ads my main concern is the one a day or two a day tabs any thoughts.
I’m trying desperately to find a solution to my moms internal bleeding caused from Xelarto. She lost so much blood so the ER gave her a blood transfusion last night and now we’re waiting and praying she gets better. Since this I’ve been researching and found the makers of Xelarto Johnson and Johnson/Bayer settled a law suit in March 2019 for 775 million dollars! If they know it’s hurt and killing people why are they still prescribing it and making it? I guess money is more important than people, evil evil bastards
Interesting because my husband has been taking Xarelto for over a year. He had a blood clot in his brain and it is now dissolved. He has not had any issues on it. His haematologist recommended it who has been in the field over 30+ years .
This is gold, doc! This is the same concern I face when discussing with fellow doctors about Pradaxa and Xarelto efficacy. The evidence sounds assuring, but the side effects seem to be hidden and not as reported.
Thank you! you answered my questions. recovering rona with a PE in the RLL. I have been having all kinds of funny side effects since starting Xarelto on Wednesday last week. I called the pharmacist on Friday to let her know and she wanted me to wait until the following Monday to see if they subside.... I realize they have to do a lot of work while we are on Warfrin, but that is what I am going to request tomorrow. My head feels like it will explode from the beginning of the first pill. slight twinges in the chest area too. And Severe shortness of breath. The SOB has subsided and not as urgent as the first few days on the drug.
I had bad side effects on Xarelto: flank, shoulder and chest pains, debilitating muscle spasms, night sweats. Switched to Eliquis and no issues thus far.
Hi my mom was prescribed elequis recently and I'm researching whether its safe. Could you please share your experience with Elequis it would be greatly appreciated. She was told to take 5mg twice daily. Thanks in advance.
Excellent summary supporting the axiom: "the newest drug is not always the best drug" and the truism that the drug most used is the one most advertised.
Eric it would be great if you could make a video teaching basics things about how to read a study and interpret data. Many of us find it difficult to understand medical statistics and epidemiology.
When an artificial substance is introduced it must affect the whole, a bit similar to an accounting ledger when one figure is change, it changes the whole.
Yes they do. Beta blocker caused massive side affects which caused dvts within weeks. Eliquis also caused continued issues but was somewhat tolerated for two months and side effects were massive. I did make 90 days and am clot free. My symptoms are finally going away after being so sick for 5 months. I believe I had a drug induced autoimmune reaction or vasculitis. Ana was positive at tiger 1:60 speckled.
I have been on Xarelto since 2011 and have had no problems, Like any medicine you should inform yourself as to any side effects and dosages and act accordingly.
wonderfully unbiased description of the events, I personally don't prescribe dabigatran for the exact same reasons you stated. In low risk patients with a precipitated DVT eg BH secondary to plaster immobilisation, I will however prescribe rivaroxaban but I do feel some guilt that the convenience plays a factor when prescribing from the ED (it is also our local policy but I still defer the high CHAD2VASC AF pts to warfarin)
+Rotund Adonis Thanks for the comment. As I say in the video, I know plenty of docs (including my wife), who still routinely prescribe rivaroxaban (though most lean away from dabigatran, as you do). And if a patient were to come to me with the strong preference of rivaroxaban over warfarin due to issues of convenience, after discussing risks/benefits, I'd be willing to prescribe it. But honestly, I've never had a patient come to me asking for rivaroxaban/Xarelto; in fact, I've had patients on rivaroxaban spontaneously tell me that they want to switch to either warfarin, or even one who preferred lifelong anticoagulation with sub-q enoxaparin injections! What may be happening is that, here in the US, a small industry is developing around lawyers specifically looking for patients who have had life-threatening bleeds on NOACs, and who then sue the manufacturer. So we see commercials on TV and the internet that start off: "Have you or a loved one suffered a major bleeding complication while taking the blood thinning medication Xarelto? If so, you may be eligible for a cash settlement..." I absolutely don't condone such commercials or lawyers whose sole business are such lawsuits, but if the public advertising makes people consider the risks of the med before starting it to begin with (including current lack of a reversal agent), it's not such a bad collateral effect.
Hi Strong! Another point is the RE-LY trial also studied dabigatran against unblinded warfarin, while it has been shown that using blinded warfarin in trials has showed a more accurate representation of the warfarin group. ROCKET-AF, ARISTOTLE, and ENGAGE all use blinded warfarin
90 pills in South Africa will cost about 3150 SA Rand's. That's about $212.55. Something is wrong in your country. Ixarola is now on the market, a slight bit cheaper.
I am on 20mg of Xarelto daily for the past 6 months now because of an Afib event 2 months after my successful Aortic Valve Replacement. Now for the last 3 to 4 months I have been getting getting heavy nose bleeds about 5-6 times a week. I went to the ENT doctor and he cortorized the weak blood vessel in my nose. But after 6 weeks it is bleeding almost daily again, so another visit back to the ENT doctor once again. I am hoping my cardiologist takes me off this drug and back on 80mg of asprain on my next visit because I have not experienced any more Afib events in over 6 months . Sometimes modern medicine Sucks, but what are the alternatives.
Great video! It's always great to hear another physicians opinion on these issues. Watching this video made me think that it would be amazing if you could do some journal club videos. My residency has a terrible journal club and after about 8 months now, I don't think my ability to critically appraise an article has improved. I know you are a busy man and have different goals for this channel, so if a journal club isn't possible, do you have recommendations on sources I can look at to better my skills at objectively reading, knowing if it's a good article and most of all, understanding and interpreting the results? Thanks.
+Kyle Murray Thanks for the comment and suggestion. Journal clubs are really tricky - it's really hard to do them well (most are boring and unhelpful), but when they're done right, they can be awesome. Unfortunately, as you correctly implied, I probably don't have the bandwidth to take on a whole new journal club series at the moment. I do however, hope to put out a video in the next ~6ish months on how to read a scientific paper generally, and another video entitled "Is most published research actually false?" which will discuss the problems of data dredging (i.e. "p-hacking") and publication bias (among other issues).
Because that's how youtube marketing works. Because you've been searching the internet for blood thinner information, google is targeting you with ads based on your searches.
I live in the UAE, Dubai to be exact. I have AFIB, almost 20 years now. My doctor said it’s chronic, and that is after two cardiac ablations. I have been on Warfrin at $10.00 per month, now I am paying $70,00 per month? I am sure my doctor is getting a kickback?
Thanks for the video, really sad that profits trump public safety. With Coumadin, besides inconvenience of monitoring INRs, you also have to worry about paradoxical coagulation. Xarelto I do not believe will run that risk. I think at the end of the day, it is physician discretion.
Question which blood thinner you think will be better because I have other issues like kidney disease and I'm trying to live I don't want to take this medicine if it's going to kill me
I'm very sorry but I can't give individualized medical advice - please speak with your doctor. However, this video is 3 years old , and during the intervening time, additional studies on these meds have been performed and published that have *not* had methodological shortcomings of similar magnitude as RE-LY and ROCKET-AF, and which are consistent with this class of medications being as safe as (if not safer than ) warfarin (a.k.a. Coumadin) for most conditions that anticoagulation is used for.
Thank you for this video. I've switched from Coumadin to Pradaxa almost a year ago at doctors suggestion for the convenience. I was told to drink a full glass of water when taking the pill to prevent stomach digestive issues. My liver functions were also checked before hand. I've had no problems with Pradaxa except that I've developed liver cysts. Are they're any new study's on liver and digestive risks using Pradaxa?
Pradaxa is associated with an increased risk of GI bleed compared to placebo (i.e. no medication), for obvious reasons. It also not uncommon to cause some mild stomach discomfort shortly after taking each pill. But I know of no association between Pradaxa and liver cysts. However, I would be sure to run any questions or concerns you have by your personal physician.
I live in Perú, I have a dvt for about two months, I was prescribed warfarin But doctors don't adjust the dosis that is better for me... so I am thinking about asking him on going to xarelto because I know about some cases that got better and faster recover from DVT. I would like to have My life as before getting this dvt... also I would like to know if all the side effects were related just for patients that got heart diseases? can xarelto be used in dvt in legs? thank you!
Hey can you please explain about your tongue.. I was in the emergency room yesterday due to a blood clot. They prescribed me 15mg Xarelto for 21 days. When I finish taking it they want me to take 20mg for 45 days..I'm leery on taking it because I am reading to many negative reviews. Do you know or does anyone know if Eloquis is recommended and is it better?
I am on 20mg of Xarelto daily for the past 5 months now and I am getting nose bleeds about 5-6 times a week.. I am hoping my cardiologist takes me off this drug and back on 80mg of asprain. Sometimes modern medicine Sucks.
Eliquis is no different than both of these. If you have afib there are better ways to treat it that don't involve blood thinners. These anticoags have more problems than they're worth. If your doctor recommends one of these things read what people taking them have to say about their experiences. To put it simply, not everyone likes the responses they are getting. In fact, most don't.
Hey! This is slightly off topic but what do you think of Entresto for heart failure? It's the ARB neprilysin inhibitor. It's fairly new and hasn't hit the market in India. Great video by the way!
Niket, I'm so sorry - I'm just seeing your question now! Here's some thoughts on Entresto that I've copied/pasted from a private correspondence a year ago, but I think it still applies. (Also, John Mandrola and Vinay Prasad have written a bit on line about Entresto; might be worth Googling their commentary since I'm sure it's better informed than my own.) "Entresto is a new medication for heart failure, approved by the FDA in July 2015, on the basis of the results of a single trial called PARADIGM-HF. At the time it was published, plenty of cardiologists were calling it a "game-changer" and "breakthrough". I had never read the trial until you told me about your dad the other day, so I read it and was bothered by a couple of serious flaws in the study design. I then sought out independent critiques of the trial, and found others with the exact same concerns that I had. Specifically, in a well designed drug trial, patients enrolled would be randomized to either receive the new drug or a placebo - both of which are designed to look the same, so patients don't know what they are getting. Unfortunately, in this case, Entresto is designed to be a combination pill of a brand new drug called sacubitril, and an older, established drug called valsartan. So what the study designers should have done was randomized patients to receive either Entresto (a combo of sacubitril and valsartan) or a combination pill of a placebo and valsartan. That is, they should only change one variable between the patient groups, so that if there was a difference, it could only be explained by the presence of absence of sacubitril. But instead, the trial compared Entresto (sacubitril + valsartan) against a combo of placebo and enalapril. Enalapril and valsartan are generally similar drugs, but the dosing was inappropriate in that the enalapril dose was moderate, while the valsartan dose was high. So between the 2 groups, there were essentially 3 different variables being changed: sacubitril vs. placebo, valsartan vs. enalapril, and high dose med vs. mod dose med. There was no explanation given in the paper for this decision, but several have been since discussed, including that sacubitril + enalapril may lead to higher levels of angioedema than either drug alone (I don't know if this effect was theoretical, or observed). Frankly, what I see as the more likely possibility is that this particular choice of comparison was done to falsely increase the chance that Entresto will appear to be helpful. In other words, Novartis (which sponsored the trial) designed the trial to maximize the chance that Entresto receives FDA approval. This is legal to do, but is totally shady. It also doesn't necessarily mean that Entresto isn't as good as Novartis claims, but we just don't know one way or the other. Entresto also received FDA approval under the "priority review program" which is usually reserved for drugs offering benefit in life-threatening diseases with no effective treatments (which is not the case here, it's not clear why the FDA agreed to an expedited review) - the consequences of this is that the review process was probably less robust than usual. Given the problems with the only trial to have looked at Entresto, and its relatively high cost, I personally wouldn't recommend it to a patient of mine (unless they were a dot-com millionairre with endless financial resources). The money saved could be better put towards other things that will have a clearer and more palpable day-to-day benefit... But there is no specific evidence that Entresto is dangerous, so if the cost could be covered somehow, it might be a more reasonable option. There is a theoretical concern that Entresto could increase the risk of Alzheimer's disease (www.forbes.com/sites/larryhusten/2015/02/09/new-heart-drug-from-novartis-will-it-raise-the-risk-of-alzheimers-disease/#6f43e1834f53 - LCZ696 was the working name for Entresto), but this has not been yet observed to be an actual effect in humans, and may be offset by the drug's cardiovascular benefit on cognition."
@@StrongMed Hello Dr. Strong. Just saw your comment! Thank you for your wonderful response! I will be applying for residency in the United States this year. Oh how the time flies! I am thoroughly enjoying your educational and evidence-based videos. Thank you! Hope you're doing well.
Strong medicine... only a question . xarelto is used for vascular dementia. i read that this drug cannot improve this disease. I read that can worse vascular dementia . What is the real truth ?
Drugs are generally not very effective for any kind of dementia. Some drugs like Aricept can be used in mild-mod Alzheimer's dementia to delay the decline in cognitive function, but the benefits are modest. Other drugs like antipsychotics can be used for severe behavioral disturbances (e.g. paranoia, delusions) seen later in all forms of dementia, and in my personal experience with my patients, seems to be more effective, but unfortunately carries a small but real increase in the risk of death due to abnormal heart rhythms as a side effect. Since Xarelto is used to prevent blood clots from developing, in theory, it should help to prevent vascular dementia by preventing some of the tiny strokes which can cause it. But I am unaware of any specific study that looks at that specific question. There is definitely no data that I'm aware of, or a reason to believe that Xarelto makes vascular dementia worse.
strong medicine .. According to you in vascular dementia are there interaction between xarelto and depakin ( antipsicotic) ? i read of interactions for the coagulation between this two drugs. So... Can depakin abolish the effect of xarelto?
Assuming you are referring to depakote (i.e. valproic acid), I am unaware of any clinically relevant drug-drug interaction with Xarelto. However, if this is a question regarding your personal health, please speak with your doctors about any concerns you have.
Recently, I was prescribed Xarelto 20 mg. Being prescribed the max dosage after having issues years ago with Eliquis. I half the pills, for my own safety, since it comes in 10, 15, and 20 mg. I am monitoring both stool and urine as well as my general well being. Having a cardiologist older than I am, I ponder his mental capacity and energy to analysis each patient effectively. In our piece of America, we don't get the cream of the crop.
What sort of issues did you have with Eliquis? If you don't mind my asking. I started taking it (first time on blood thinners) 9 weeks ago. Hoping for the best.
Hate having to take Any blood thinner!! BUT...since diagnosed with AFib a month ago and having other comorbidities, I would not want to put myself in a very high risk stroke category by not taking a blood thinner. I have been prescribed xarelto. So far......Sooo good!
I was diagnosed with a PE most likely because I broke my foot, had a soft cast and had to have my foot immobilized for about a week to 10 days. The doctors insist I use Xerelto for 6 months. I am adamantly against it but conceded to take it for the 6 months. I have no other health/cardio problems. Questions: 1) why six months of use (seems arbitrary) and 2) what are natural blood thinners if I have to be on this type drug?
I can't give you specific medical advice on here, but will tell you that 6 months is arbitrary, and I'll link to the latest guidelines on the management of "venous thromboembolism" (an umbrella term that includes both PE and DVT): www.sciencedirect.com/science/article/pii/S0012369215003359 The most relevant section for your question #1 is "Duration of Anticoagulant Therapy". For #2, there isn't any "natural" blood thinners, at least none that would be remotely safe to use. However, please talk to your physician about your concerns, and don't change your medical thearpy on your own solely based on a RU-vid video!
Hi Strong Medicine is Eloquis better than Xerelto? I am asking because I was in the ER last night.. I have a blood clot.I thought they would keep me overnight but they sent me home with 2 prescriptions of Xerelto.My first one they want me to take 15mg for 21 days. My 2nd one they want me to take 20 mg for 45 days after I am completely done with the first 21 day dose.. Can you please advise
My mom (81 yrs) had a PE after ankle break and surgery. Docs diagnosed PE while in post op at hospital. She was on Pradaxa for 1 year. Just finishing last bottle and her Dr said she could stop. We were worried about risks of bruising…Good luck with your health.
Recently Dabigatran started to be used more and more in my country(Romania)but it's still not very popular due to the high price.Doctors tend to use it on patients that live far from a medical center,or have mobility problems and they can't test their INR.What about Acenocumarol?That's what we mostly use here
+manymarius Acenocoumarol like warfarin is a coumarin derivative. Both warfarin and acenocoumarol are vitamin k antagonist anticoagulants. I hope this helps.
I am on Xarelto and have no problems - but suddenly Kaiser Perm wants me to switch to Pradaxa - which is taken twice a day and if you don’t take it with food - Heartburn - three alarm levels. Why are they switching me ???
I wouldn't want to speculate myself, but the prescribing doctor should be able to tell you. Some healthcare systems will switch drugs within the same exact class without necessarily getting approval from the physician (i.e. I believe the VA had done this with proton-pump inhibitors while I was there). However, Xarelto and Pradaxa - while very similar - are not in the same exact class, and the pharmacy should get approval from the doc before making that change.
I'm on Lovenox (Enoxaparin) which doesn't require routine monitoring, and have been on it for about 4+ years (on it for life due to recurring of DVT). My understanding is that Praxada works in the same methods that Lovenox does but in pill form, is that not accurate?
Enoxaparin and Pradaxa are both anticoagulants, and it's true that enoxaparin is given as a subcutaneous injection while Pradaxa is a pill, but they work in slightly different locations in the body's clotting pathway (i.e. different mechanisms). There are several reasons a doctor might prescribe enoxaparin over Pradaxa, related to the indication (i.e. why it's being prescribed), and to their patient's other medical problems.
Thanks for the follow-up. I was initially on Warfarin many years back but I built an immunity against it and developed a 3rd recurrence of a DVT, it was the reason why I was switched to Enoxaparin. At the time there wasn't many other options of oral anticoagulants that were FDA approved. I had done a bit of research and found that Pradaxa and Xarelto were already approved in other countries, just not in the US for DVT due to strict FDA rules of approval. In 2014 the drug Pradaxa was finally approved for DVT and I was very much excited to get off the Enoxaparin, but my doctor advised to wait until it was proven stable and the 'kinks' were worked out. Three years have gone by and now I've been given the option by my doctor to switch, but with all this bad publicity I'm beginning to have second thoughts and may just wait another while.
My doctor insists I take xarelto when I argued with her she said "do you want to have a stroke"? She did advise of the side effects and the risk of bleeding. As patients what can we do?
you should get a new doctor, one that will listen to your concerns and not act like an authority figure. It is ultimately your health, your money and your choice, you have the power over your health not her! And dont let her scare tactics frighten you either, (she gets a piece of the pay check for selling drugs as well) there are always many other options, try searching up "functional medicine" doctors in your area, their expertise in chronic disease is profound. Usually those doctors are also much more open minded and educated in reading and keeping up with research
No doctor should make any kind of comment that will scare you into taking a drug you're skeptical about. Definitely, get another doctor. There are other ways of dealing with afib that are more effective than these blood thinners and they don't involve side effects that can kill you.
+levi2bear Well, it's a little complicated by the fact that I work at an academic center with residents, and I like to provide residents as much autonomy as possible. We also have an active cardiology consult service. So if my resident or the cardiology consult attending has a strong preference for a NOAC in a particular FDA-approved situation, it would need to be a very unusual situation for me to veto it - though I will personally discuss the harms and benefits of all options with the patient. If the resident has no strong opinion, and a cardiologist is not actively involved in the case, I put/keep patients on Coumadin, unless the patient volunteers a strong preference for a NOAC.
I'm sorry the series remains unfinished. Based on a poll of subcribers from the fall, there was much less interest in completion of the heme videos as compared to a few other topics which I'm working through now (e.g. EBM, antiarrhythmics, AKI). I'll definitely come back to heme (the videos are already all outlined out), but unfortunately can't offer an estimate of when that might be.
I think a statement of whether not you have financial disclosures is appropriate if you are going to make a video like this. Saying that warfarin is your preferred oral anticoagulant does not excuse that responsibility.
You are absolutely right! I've added such a statement to the video description, and will try to remember to include it in the next iteration of my channel trailer (which will hopefully be coming soon).
Well now I'm a little freaked out. I just got a blood clot.... probably cause I have a spinal cord injury, and I was prescribed e xarelto. Just took first dose.... what should I do? Just take aspirin? My leg is still all swollen...
I can't offer medical advice here, but do NOT stop taking your Xarelto just because you watched this video. Discuss concerns that you have with your doctor.
I am taking 20mg as from today now on my 2nd month and my clot hasn’t gone .i was taking 15mg x 2 times a day I was disappointed it didn’t work ‘😢 so I was advised to do the 3 month treatment , I don’t feel comfortable taking them as I need to watch the way I live not to upset my body // bleeding bruising massive headaches ....
In 2020 I had an episode of a fib spent 4 days in hospital and the hospitalist Doctor prescribed apixaban or eliquis which I took for a couple of years being new eliquis was expensive when in the “ donut hole” my copay was $100 it irked me every time I payed that and there was some miscommunication with y My insurance company about the method of payment so I myself decided to switch to Coumadin or warfarin asked my pharmacist and Doctor some questions and went to my cardiologist and switched to warfarin which I am taking today but here is the main point ! For reasons I will not go into I asked the Doctors if I should go back to taking eliquis and they all said NO warfarin is best for you why did they give me eliquis in the first place if warfarin in what they say is the better choice I’ll never know thank you makes you wonder yes
What are possible symptoms of bleeding while using Xarelto? Symptoms of potentially serious bleeding can vary, but they may include: any bleeding that’s severe, lasts a long time, or won’t stop frequent nosebleeds unusual bleeding from your gums unexpected vaginal bleeding or menstrual bleeding that’s heavier than usual blood in your urine, which may be red, pink, or brown in color blood in your stool, which may be red or black in color, or look like tar vomiting blood, which may be red or pink in color, or look like coffee grounds coughing up blood that looks like coffee grounds severe headache dizziness, which could be a sign of low blood pressure that’s caused by internal bleeding joint pain pain, swelling, or bleeding at any wounds
Im going to have to respectfully disagree. I love all your videos but this one im going to have to disagree with. The future will be in NOAC therapy. Apixaban data is underway and all my patients that have been on it so far are doing well. No horror stories. Your not going to have any perfect trials but you can look at a meta-analysis of all trials for the NOACs(Lumping dabigtran, riveroxaban and edoxaban also), they are noninferior and if anything superior to warfarin. Warfarin will likely still claim valvular a.fib given the mechanics of the clot, but otherwise NOACs will dominate in the near future especially with the possibility of newer agents for reversibility. Will see if my prediction pans out or not. :)
Thanks for watching and for your comment, and sorry for my delayed response! The point of the video wasn't to say that NOACs aren't the future - but that the data specifically for rivaroxaban and dabigatran (in early 2016 - when the video was made) was too flawed to trust. Subsequent studies have since come out that also demonstrate safety. And to the best of my knowledge, there have not been similar issues with apixaban - which is currently my "go to" NOAC (when our pharmacy approves it). But even if one becomes convinced that rivaroxaban and dabigatran are superior to warfarin (and we'll probably get there, either with these drugs or ones in development), they will nonetheless remain important case studies in the problems of drug regulation due to the issues around their initial approval.
Is apixaban safe? My mom was prescribed it but we are scared about her having brain bleeding. Her cardiologist strongly advises her to begin taking it and calls my moms gp regularly asking if she has begun. My mom has afib and had a TIA recently and is 70 years old with diabetes. Big pharma deception has poisoned peoples trust in medicine. Any information you could offer would be greatly appreciated. Thank you
Your predictions are wrong because you dont diagnose properly in the first place and then you cannot distribute properly and then you get major problems and soon the medication, in this case, is banned.
