Warfarin or Pradaxa? Making the choice.

Dr. Geoffrey Barnes weighs the pros and cons of atrial fibrillation meds

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Atrial fibrillation (also know as Afib) is a quivering or irregular heartbeat (arrhythmia) that can lead to blood clotsstroke, heart failure and other heart-related complications. According to the American Heart Association, approximately 2.7 million Americans are living with Afib.

Atrial fibrillation has long been treated with the blood thinner Coumadin, also known as warfarin, which was approved by the FDA in 1954. However, new blood thinners, or anticoagulants, to treat Afib have come on the market in the last six years, including one known as Pradaxa. Continue reading

4 nutrition habits that might be hurting you

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Many of us grew up with nutrition habits we thought were healthy. But, according to today’s standards, some of those habits should be laid to rest …

1. I eat vegetables every day at dinner, so I’m healthy.

Not so fast! Eating one serving of vegetables a day will no longer cut it, especially if they’re starchy vegetables like corn, peas, potatoes, sweet potatoes or winter squash. Although still good for you, a serving of these actually counts in place of bread, pasta or rice. For optimum cardiovascular health, aim to eat half a plate of non-starchy vegetables — asparagus, broccoli, carrots, cauliflower, green beans, lettuces, onions, peppers, tomatoes and zucchini — at lunch and dinner. Aim for at least five or six cups of raw leafy greens or three cups cooked or raw vegetables every day, and remember: There’s no maximum on these non-starchy vegetables. They pump you full of fiber and phytonutrients and are low in calories.   

When taking a blood thinner such as warfarin, it’s important to maintain a healthy intake of vegetables — no more “I’m on a blood thinner so I can’t eat veggies.” Instead, be consistent with Vitamin K content from day to day and you’ll have no problems and be healthier. Continue reading

Goodbye to blood-thinners?

Breakthrough treatment for Afib might be right for you

Afib-Blog_resizedAtrial fibrillation, or Afib, is the most common cardiac arrhythmia, resulting in a fast or irregular heart rhythm among more than 5 million Americans. Afib is traditionally treated with blood-thinners or anticoagulants such as warfarin, but a new device, recently approved by the FDA, is changing the way Afib is treated.

The WATCHMAN™ Left Arial Appendage Closure Device offers patients with non-valvular atrial fibrillation a potentially life-changing stroke risk treatment option that could free them from the challenges of long-term warfarin therapy.

The Frankel Cardiovascular Center is among the first heart centers in the nation to use the WATCHMAN Device. With stroke being one of the most feared consequences of Afib, the WATCHMAN Device has proved to be a viable alternative to blood-thinning medications, which are not well-tolerated by some patients and have a significant risk for bleeding complications. Continue reading

Top 5 Takeaways on Stroke

Dr. Eric Adelman's Mini Med School presentation focuses on stroke prevention and treatment

mini_med_school_cardiovascular_graphic stroke BlogLeading U-M Frankel CVC researchers and physicians are advancing knowledge, finding new treatments and applying new technologies. Each week one of them shared his or her expertise in a six-week Mini Med School community education program focused on cardiovascular topics.

Here are the Top 5 Takeaways from Dr. Eric Adelman’s Mini Med School presentation on Stroke Prevention and Treatment:

1. Know the signs of stroke

Brain damage can begin within minutes of experiencing a stroke, so it’s important to know the signs of stroke and to seek immediate treatment by calling 911. Rapid treatment can significantly improve your outcome.

Common stroke symptoms experienced by both men and women include:

  • Sudden numbness or weakness of face, arm or leg, particularly on one side of the body.
  • Sudden trouble speaking or understanding.
  • Sudden trouble walking or difficulty with balance or coordination or dizziness.
  • Sudden difficulty seeing or double vision.
  • Sudden severe headache without a clear cause.

FAST (Face drooping, Arm weakness, Speech difficulty, Time to call 911) is an easy way to remember the sudden signs of a stroke. When you spot the signs, call 911 for help.

2. Maintain a healthy blood pressure

Half of all strokes are attributed to high blood pressure. If individuals with high blood pressure can drop the top number of their blood pressure reading by 10 points, they can reduce their risk of stroke by 25 to 30 percent. Most people need medication to lower their blood pressure, but lifestyle factors can also play a role. Don’t smoke, get regular exercise, eat a healthy diet (e.g., Mediterranean diet) and try to avoid added salt.

3. Afib is a risk factor

Individuals with atrial fibrillation (Afib) have an increased risk of stroke, so it’s important to take your medication (warfarin or other anti-coagulant) on a regular basis to help reduce your risk of stroke.

4. Prevention is key

It’s much easier to prevent a stroke than to treat one, so be proactive if you have certain risk factors. For example, if you have diabetes, take the necessary steps to control it. Make sure your cholesterol is well-managed. And keep your blood pressure under control.

5. New device to treat stroke

A new type of device known as a stent retriever has shown tremendous promise in treating stroke patients. Stents, similar to the ones used to open clogged heart arteries, are being used to clear a blood clot in the brain, reducing the amount of disability after a stroke. The stent is temporarily inserted via catheter through the groin to flatten the clot and trap it, and is then removed with the clot. The stent retriever procedure is used for patients with severe strokes.

Take the next step:


Adelman_eric150x150Dr. Eric Adelman is assistant professor of neurology at the University of Michigan and co-director of the U-M Comprehensive Stroke Center. He received his medical degree from Northwestern University Feinberg School of Medicine.

 

 

 

Frankel-informal-vertical-sigThe University of Michigan Samuel and Jean Frankel Cardiovascular Center is a top-ranked heart and heart surgery program among Michigan hospitals. To learn more, visit our website at umcvc.org. The U-M Stroke Program is accredited as a Comprehensive Stroke Center by the Joint Commission and participates in the American Stroke Association “Get With The Guidelines®” Quality Initiative.

Beyond the sticker shock of Warfarin alternatives

Analysis shows costs savings without frequent blood draws and fewer complications

Pills spillDoctors who are worried about the risk of stroke among their patients with the abnormal heart rhythm atrial fibrillation often look to anticoagulants for help – medicines that prevent dangerous blood clots, but can cost a lot.

Cardiovascular specialists at the University of Michigan Frankel Cardiovascular Center looked at the cost of dabigatran (Pradaxa) which is part of the new class of anticoagulants. They are simpler to use and less risky than Warfarin.

Medicare will spend an average of $75,496 to cover the cost of dabigatran for a 65-year-old with Medicare Part D coverage, compared to Warfarin’s cost of about $61,586. Research by the University of Michigan presented at this week’s American Heart Association scientific sessions reveals that in spite of the price tag, the new medicines can be cost-effective.

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Advantages of warfarin and Coumadin alternatives

All drugs have both advantages & drawbacks based on individual medical needs

Anticoagulants like Coumadin or Jantoven are prescribed to prevent the formation of blood clots.

Three new drugs were recently approved as warfarin and Coumadin alternatives.

Up until recently, when physicians treated patients for thromboembolism (blood clots) or patients who might be at risk for the development of a blood clot, the only oral drug available was warfarin. Warfarin (brand names Coumadin or Jantoven) has been around for years, and when used appropriately is a safe treatment plan for reducing the risk of stroke and blood clots. Like any medication, there are always potential side effects or risks. Also, like any medication, those risks are weighed against its potential benefits, thereby allowing a treating physician to make the most appropriate treatment plan for an individual patient.

Warfarin drawbacks

There are four main drawbacks to taking Coumadin or Jantoven:

  1. Regular blood draws are required to be sure the right dose is being administered (every patient’s dose is specific to their body’s response to the drug).
  2. There are many potential drug interactions with warfarin that may lead to either an increase or decrease in its blood levels.
  3. All the cruciferous vegetables (those foods high in Vitamin K, such as cauliflower, cabbage and broccoli) counteract warfarin, making dietary guidelines for anticoagulants very important.
  4. There is a narrow therapeutic index for warfarin, which, in some patients, may lead to very difficult warfarin dosing. If the blood level is too low it will not be effective and if it is too high, there is an increased chance of bleeding.

Continue reading