dabigatran vs. rivaroxaban

[spacecowgirl]

Dabigatran Association With Higher Risk of Acute Coronary Events Meta-analysis of Noninferiority Randomized Controlled Trials

Arch Intern Med. Published online January 9, 2012. doi:10.1001/archinternmed.2011.1666

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[dmartin1910]

Anybody has those on their formulary yet?

Both are non-inferior to warfarin. For an inpatient setting, at $6-7/day cost to pharmacy, Pradaxa is probably cheaper than warfarin + daily INR (not sure about exact lab cost). Rivaroxaban would be cheaper than 30 mg lovenox BID post hip/knee op.

Any hospital out there going these routes? Of course, warfarin would still likely be cheaper for outpatient 1x/month INR. But we are talking inpatient acute care setting. We can bridge them over to warfarin near discharge.

I wonder when Apixaban is going to get approved.

Our hospital has Xarelto on formulary since it can be used at 10 mg. for ortho surgery indications and 20 mg (or 15) for afib pts, If starting because of procedure and bridging from Warfarin to Xarelto when INR is less than 3 (often don't have to wait...next dose), then only have to DC 24 hours before surgery and can restart 18 hrs. after epidural introduced/6 hrs. minimum after removed (unless traumatic puncture, but not usually applicable). The rationale is less time with increased thrombogenesis risk. Some pts. are bridging back to Warfarin when discharged due to cost. Usually a couple of days. It's cheaper and better compliance than bridging with Lovenox.
And of course, starting on it because of nv afib diagnosis or switching from coumadin is easy. As long as INR < 3.0 start on Xarelto at the next evening meal.

 

[xiphoid2010]

Our hospital has Xarelto on formulary since it can be used at 10 mg. for ortho surgery indications and 20 mg (or 15) for afib pts, If starting because of procedure and bridging from Warfarin to Xarelto when INR is less than 3 (often don't have to wait...next dose), then only have to DC 24 hours before surgery and can restart 18 hrs. after epidural introduced/6 hrs. minimum after removed (unless traumatic puncture, but not usually applicable). The rationale is less time with increased thrombogenesis risk. Some pts. are bridging back to Warfarin when discharged due to cost. Usually a couple of days. It's cheaper and better compliance than bridging with Lovenox.
And of course, starting on it because of nv afib diagnosis or switching from coumadin is easy. As long as INR < 3.0 start on Xarelto at the next evening meal.

Both are still officially non-fo right now but are kept in stock. I am a little suprised that despite pradaxa's head start, xarelto seems to have gained more traction. Probably the question of pradaxa's bleeding and cardiac risk being all over the news. I'm sure xarelto sales reps are taking full advantage of it.