Pradaxa (dabigatran etexilate) ..... coming to an ED near you?

This drug was recently approved by the FDA to reduce the risk of stroke in patients with atrial fibrillation and I saw my first patient on it a couple days ago.   Knowing nothing about the drug, I had to do a little reading up on it.  Here's what I found.

The huge advantage of this over warfarin is that the dosage is fixed and there is no need for close blood level monitoring.  The efficacy in preventing stroke when compared to warfarin seems about equal and the risk of bleeding seems about the same as well.  A month supply of Pradaxa will cost about $230 compared to about $50 for warfarin.  Whether insurance companies will help cover the cost of Pradaxa as they do warfarin is anybody's guess.  I suppose it will depend on the total cost of warfarin, including costs of monitoring and paying for all those hospital admissions for supratherapeutic INR's.  For patients who have overdosed on Pradaxa, there is no antidote.  Treatment is primarily supportive along with some experimental treatments - dialysis and FFP - which might help.  


Source

Dabigatran etexilate: Drug information.  Lexi-Comp.

Epocrates Online.  https://online.epocrates.com/noFrame/

Pradaxa.com Website.  "Prescribing information"  http://bidocs.boehringer-ingelheim.com/BIWebAccess/ViewServlet.ser?docBase=renetnt&folderPath=/Prescribing%20Information/PIs/Pradaxa/Pradaxa.pdf