{"id":48376,"date":"2014-07-25T10:29:58","date_gmt":"2014-07-25T14:29:58","guid":{"rendered":"http:\/\/1boringoldman.com\/?p=48376"},"modified":"2014-07-25T10:30:48","modified_gmt":"2014-07-25T14:30:48","slug":"miles-to-go-3","status":"publish","type":"post","link":"https:\/\/1boringoldman.com\/index.php\/2014\/07\/25\/miles-to-go-3\/","title":{"rendered":"miles to go…"},"content":{"rendered":"\n

Back in February when I first read about Pradaxa® [how many examples?…<\/a>, foot-in-mouth disease…<\/a>], I couldn’t help but comment even though it had nothing to do with psychiatry. Without even reading the articles, just the basic premise was suspicious – that Boehringer Ingelheim had introduced a "blood thinner" [anticoagulant] that didn’t have to be monitored with blood tests. After a medical lifetime of monitering people on Warfarin with monthly clotting tests, I couldn’t figure how one could achieve the same results with a medication that didn’t have to be monitored. And when I actually read the articles, I still couldn’t. To me, Pradaxa® is a nightmare. It is an anticoagulant that, unlike Warfarin, can’t be reversed if a person has a bleeding episode. Having spent plenty of nights in a former career pumping patients full of Vitamin K to reverse dangerous bleeding, I wondered what one was to do when a person on Pradaxa® slarted bleeding. I had a vision of the little Dutch Boy trying to stop leaks in the Dyke and running out of fingers.<\/p>\n

So why would I put someone on a medicine to prevent thromboembolism that cost 60 times as much and seemed pretty dangerous just for the convenience of skipping monthly blood tests? I wouldn’t. It’s that simple. And as fate would have it, within a few weeks of reading those articles, a friend with Atrial Fibrillation was put on the medication. I did my best to dissuade him, but his doctor carried the day recommending the convenience of Pradaxa®. To my relief, a cardioversion was successful in reversing his Atrial Fibrillation, and he was taken off of anticoagulants.<\/div>\n
\n
Dabigatran: how the drug company withheld important analyses.<\/a><\/div>\n
by Cohen D. <\/div>\n
British Medical Journal<\/font><\/strong>. 2014; 349:g4670.<\/div>\n
[full text on-line]<\/a> <\/div>\n

<\/p>\n

Concerns over data in key dabigatran trial.<\/a><\/div>\n
by Cohen D. <\/div>\n
British Medical Journal<\/font><\/strong>. 2014; 349:g4747. <\/div>\n
[full text on-line]<\/a> <\/div>\n

<\/p>\n

The trouble with dabigatran.<\/a><\/div>\n
by Charlton B and Redberg R. <\/div>\n
British Medical Journal<\/font><\/strong>. 2014; 349:g4681.<\/div>\n
[full text on-line]<\/a> <\/div>\n

<\/p>\n

Dabigatran, bleeding, and the regulators.<\/a><\/div>\n
by Moore TJ, Cohen MR, and Mattison DR.<\/div>\n
British Medical Journal<\/font><\/strong>. 2014; 349:g4517.<\/div>\n
[full text on-line]<\/a><\/div>\n<\/blockquote>\n
This weeks BMJ hit the ground running on the Pradaxa® story, and good for them. It’s is full of detailed articles documenting the whole mess. There’s plenty of blame to go around: NICE, the FDA, Boehringer Ingelheim, and all physicians involved – including the one that recommended it for my friend, a Habitat for Humanity crew chief who jumps in to do the jobs other volunteers don’t know how to do. I can just hear the phone call that he fell from a ladder [again]. Around that same time he was started on Pradaxa®, a cardiologist from the same practice frowned with disapproval when I declined his recommendation that I take a Statin for my until-recently-normal<\/em> LDL [although I did get a laugh when I added "I don’t need a Mammogram either"].<\/div>\n","protected":false},"excerpt":{"rendered":"

Back in February when I first read about Pradaxa® [how many examples?…, foot-in-mouth disease…], I couldn’t help but comment even though it had nothing to do with psychiatry. Without even reading the articles, just the basic premise was suspicious – that Boehringer Ingelheim had introduced a "blood thinner" [anticoagulant] that didn’t have to be monitored […]<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_bbp_topic_count":0,"_bbp_reply_count":0,"_bbp_total_topic_count":0,"_bbp_total_reply_count":0,"_bbp_voice_count":0,"_bbp_anonymous_reply_count":0,"_bbp_forum_subforum_count":0,"footnotes":""},"categories":[2],"tags":[],"class_list":["post-48376","post","type-post","status-publish","format-standard","hentry","category-politics"],"_links":{"self":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/48376","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/comments?post=48376"}],"version-history":[{"count":35,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/48376\/revisions"}],"predecessor-version":[{"id":48411,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/48376\/revisions\/48411"}],"wp:attachment":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/media?parent=48376"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/categories?post=48376"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/tags?post=48376"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}