A recent analysis of the new anticoagulants to replace Coumadin (Warfarin) is looking quite favorable when treating blood clots. This is expanding their indication, usage and safety.
In the U.S. the two alternatives are PRADAXA and XARELTO, with Xarelto appearing to be somewhat more advantageous with less issues from bleeding.
Such alternatives are sorely needed and provide a great deal of benefit as regards convenience as they do not require blood monitoring.
On the other hand, there is no ready ‘antidote’ to these new anticoagulants, and until more experience accumulates as to their safety in various populations, we will remains slow to adopt their usage across the board.
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Blood clots often occur without a specific cause or explanation. When they occur after surgery , prolonged bed-rest or a long plane trip after trauma to the leg, or when a woman is newly placed on hormones, we can understand the factors that were underlying their development, but often they occur spontaneously without such explanations.
After appropriate treatment, which is usually injectible heparin, followed by 6 months of Coumadin, we are at a loss to provide the best ongoing treatment and prevention.
Sometimes we ask patients to stay on Coumadin indefinitely to prevent future recurrence, but this is fraught with concerns about lifetime anticoagulation and the potential for bleeding in the future.
An alternative path appears to have been found and is reported in the latest article in the NEJM (New England Journal of Medicine).
Patients with spontaneous blood clots were studied and after treatment were randomized to receive low-dose aspirin daily or nothing at all. Although future blood clot occurrence was the same in both groups, the group on aspirin had fewer heart attack, strokes, and had a lower death rate.
So…it appears that low dose aspirin is beneficial in this group of patients as a ‘third option’…and provides a 33% reduction in future serious health consequences. This is a consideration to avoid the long-term consequences of Coumadin, while still attaining improved outcome in the long term.