Real-World Feedback on Pradaxa
Heartfelt blogger Melissa Walton-Shirley, a cardiologist, offers important experiential praise and criticism of Pradaxa (in contradistinction to my paper-based and generally unwavering praise of the drug).
Turns out that one of the potential downsides of the pill is, in fact, one of its biggest assets: freedom from warfarin-like drug monitoring. It seems that the idea of periodically testing and monitoring an anticoagulant's effect has been so engrained in the practice of medicine (and specifically cardiology) that physicians actually miss the tangible feedback. Who knew? This issue becomes a particularly touchy one when providing anticoagulation to the potentially renally compromised elderly—at least according to Walton-Shirley and a few commenters.
Another area of practical hedging: when to discontinue Pradaxa before surgery. Apparently surgeons are tap dancing on a recommendation that spans 3-5 days pre-op. As Walton-Shirley asks about this "gray zone": "Well, is it three or is it five?"
