Popular Blood Thinners May Lead to Brain Bleeding after Head Injury

Blood Thinners

A three-year study of more than 1,000 patients found that the risk of delayed intracranial hemorrhage and death following head trauma was significantly higher for adults taking older blood thinning medications including clopidogrel (Plavix) and warfarin (Coumadin), according to research being presented today at the annual meeting of the Radiological Society of North America (RSNA).

The effects of newer blood thinners such as Pradaxa and Xarelto were not included in the report.

Taking aspirin concurrently with any blood thinner may increase the risk of delayed hemorrhage.

Intracranial hemorrhage occurs when blood vessels within the brain rupture, releasing blood into the brain tissue. In a delayed traumatic intracranial hemorrhage, bleeding in the brain occurs after the initial trauma, usually within 48 hours, after an initial negative head CT.

High blood pressure, head injury and the use of blood thinners are known causes of intracranial hemorrhage. As the population ages, the prevalence of patients taking blood thinners is increasing.

“The incidence of delayed posttraumatic intracranial hemorrhage in patients on different types of blood thinners with and without the addition of aspirin is not well established,” said Warren Chang, M.D., neuroradiologist and director of research at the Imaging Institute of the Allegheny Health Network in Pennsylvania. “This is an active area of investigation, especially as novel blood thinners become more widely adopted.”

Pradaxa vs Xarelto: Comparing Blood Thinners

Pradaxa

Until the last decade, the only option available for patients with nonvalvular atrial fibrillation to help control blood clots was Coumadin (also known as warfarin). While effective in preventing intracranial bleeding, patients on Coumadin have to endure regular blood tests and risk major bleeding complications. Now there are new drugs known as non-vitamin K antagonist oral anticoagulants (NOACs).

The two anticoagulants at the forefront of the blood thinner market are Pradaxa (dabigatran), made by Boehringer Ingelheim, and Xarelto (rivaroxaban), manufactured by Johnson & Johnson’s Janssen Pharmaceuticals division. Both of these blood thinners are considered by some doctors to be safer and more effective than Coumadin. But they still come with increased risk of severe bleeding that have resulted in patients filing both Xarelto lawsuits and Pradaxa lawsuits by the thousands. Additionally, they are more expensive and may impact the renal system with prolonged use.

Because of these issues, we decided to do a head-to-head comparison between the two biggest rivals in this class of new blood thinners. Patients trying to choose the right blood thinner should consider the following things when weighing their options.

Blood Thinners Pradaxa, Xarelto Have New Competitor in Eliquis

Pradaxa

After twice delaying approval of the drug, the U.S. Food and Drug Administration (FDA) has now cleared Eliquis for the prevention of stroke and dangerous blood clots in patients diagnosed with non-valvular atrial fibrillation, the most common type of heart rhythm abnormality.

Eliquis, developed by Bristol-Myers Squibb and Pfizer, is the latest addition to a family of three next-generation blood thinner drugs approved by the FDA in the last two years; the others are Pradaxa and Xarelto.

FDA approval of Eliquis came after the drug’s approval in Japan and the European Union, and several months before the scheduled ruling set for March 17, 2013. The agency initially was expected to make the decision in March 2012, but requested more time to review new data.

By June 2012, the FDA had again postponed the drug’s approval as it awaited results from ARISTOTLE, a clinical study comparing the safety and effectiveness of Eliquis to warfarin, a more dated anticoagulant, in more than 18,000 patients with non-valvular atrial fibrillation.

New Drug, Familiar Risk
Eliquis, Pradaxa and Xarelto were all developed as alternatives to warfarin, which the FDA approved nearly 60 years ago. Although warfarin was once the go-to treatment for patients with atrial fibrillation not caused by a heart valve problem, its safe use requires regular blood monitoring by doctors.