Pradaxa: Anti-Coagulants & Dentistry

Yesterday I had the pleasure of working on a very nice patient who also happened to be a physician! I was doing his examination & we started chatting and reviewing his medical history. He stated that he recently had been to Africa and unfortunately had become very sick and experienced: paroxysmal atrial fibrillation (abnormal rhythm of the heart) and was placed on a drug called: Pradaxa (generic name: dabigatran)
I learned two lessons today: 1) I was reminded how important it is for a medical history to be updated at each dental appointment, and 2) I met my first patient who was using Pradaxa (a new anticoagulant drug).
Now, I know that I am over-simplifying but if you have abnormal rhythm of the heart, the heart doesn't send blood out to your lungs and your organs efficiently and there are all kinds of problems that result from that - the most important being the increased risk of stroke (the 3rd leading cause of death & leading cause of disability - information courtesy of: Dr. Pullen - you can see his information here: http://drpullen.com/pradaxa)
But what I REALLY want to talk about from a dental standpoint is the medication treatment after being diagnosed with atrial fibrillation - which has always been an anticoagulant: either coumadin (aka: warfarin), IV administered HEPARIN, or ASPIRIN. But this patient was placed on PRADAXA.Why do I care as a dentist about anticoagulation drugs (such as warfarin/coumadin and now, Pradaxa)?
The reasons are many: to understand your comprehensive medical history, to expect more bleeding when a cleaning is performed, but MOST importantly because if I need to perform surgery or an extraction of a tooth, I need you to STOP bleeding after. If you can't clot because your blood is too thin, the extraction site is like an open wound that just keeps bleeding and can, if not caught, can lead to mortality. And that is DEFINITELY not something anyone wants.
I have seen Pradaxa commercials on television but I didn't know much about it. So of course, I looked up history and information of the drug. I am not a medical physician but here are a few things that I found:
-it was developed by the pharmaceutical company Boehringer Ingelheim.
- it was FDA approved October 2010 and approved to be put into effect February 2011 (so a relatively new drug - out less than a year)
- usually dosed to a patient at 150mg two times a day
- upon taking Pradaxa it is effective within a few hours of taking it vs. coumadin/warfarin where the dosage is a little tricky and you have to go in for tests all the time before you can get the dosage correct
- it supposedly has "fewer drug interactions" than warfarin
- as it is a new drug it is more costly & the long-term side effects are still not yet determined
Either way, from a dental standpoint it is important for me to be aware of this drug and put it on my "anti-coagulant radar" so that if I can be aware of any potential complications & plan your dental treatment accordingly. I am excited to hear that there is an easier alternative to coumadin - that can save lives and help in the prevention of stroke & further medical complications!
If I find out more I will let you know and keep you updated!! And if you see your dentist, please update him or her on your new medications. It could save your life!!!
image courtesy of: noprescriptioneeded.com