Biotech Values

[biopearl]

Dew, Electrophysiologists have developed a comfort level doing complex procedures like Afib ablations on full dose coumadin (INR 2-3) including transseptal puncture. Coumadin is reversible with fresh frozen plasma and (eventually) with vit K. Pradaxa at least so far is not reversible except by time. The importance of this is that if a disaster occurs during a procedure the bleeding risk is higher with the latter drug. Attempts to stop Pradaxa and use heparin bridging can be done but presents its own set of problems which I can outline if you wish. Also some theoretical and maybe not so theoretical rebound hyercoagulation states might also occur (not proven, just suspected by some). In my limited experience with patients withdrawn from Pradaxa for catheter based procedures small clots occurred in two patients on catheter tips (which were fully retrieved) despite adequate heparinization during the procedure. I prefer to do some catheter based procedures with the patients fully coumadinized and rarely have bleeding problems. I agree with this study's findings. For our patients on Pradaxa who anticipate certain procedures, we actually stop the Pradaxa and switch them to coumdin before their procedures. Many switch back at a later time. Hope this helps. Regards, bp