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Having atrial fibrillation. Prescribed with pradaxa 150mg to be used for life long. Is it safe to take the medicine for life time?

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Practicing since : 1998
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Hi Doctor

I need urgent advice on following:
- My mom is diagnosed with AF (Tachycordia). Initially, she was prescribed "Pradaxa 150mg" by a cardiologist- she used it for 30 days. After that, as she is in a different town, she went to a different cardiologist for follow up. The second cardiologist recommended to not use this medicine rather metaprolol is sufficient to control AF
- Then, for the last 3 months, she stopped takin Pradaxa 150mg.
- When we checked her heart beat rate recently, it;s still at 130bpm at times
- then, we went to the first doctor who suggested Pradaxa medicine. He is suggesting to use this for life long to reduce heart blocking problem in the long term

I need your advice on pros and cons of using Pradaxa 150mg for my mom

This is little urgent - can you pls advice.

Posted Sat, 31 Aug 2013 in Heart Rate and Rhythm Disorders
Answered by Dr. Sukhvinder Singh 25 hours later
Brief Answer:
please see the detailed answer below.

Detailed Answer:
Respected Sir
1. Pradaxa (debigatran) and metoprolol are two different drugs belonging to different class of drugs and have different roles in atrial fibrillation (AF).
2. In AF we have different goals of treatment. They are control of ventricular rate (i.e. the rate of pumping of main pumping chamber of heart), reverting AF to normal rhythm and preventing formation of blood clots in atria (receiving chambers of heart) which can go anywhere in body and can cause paralysis etc.
3. Metoprolol is a beta-blocker which is meant to reduce the ventricular rate and keep it within permissible limits. It does not have any role in reversion to normal rhythm or prevention of clot formation. It is the decision of your cardiologist whether to go for rate control only or to go for reversion to normal rhythm. The dosage is increased unless the rate is optimally controlled or the side effects appear.
4. Pradaxa is an oral direct thrombin inhibitor used to prevent formation of clot in patients with non-valve disease related AF. It is one of the so called blood thinners. The choice of blood thinner depends upon various risk factors. since your mother is having high blood pressure, she has at least one moderate and low risk factor for clot formation and most of cardiologist will choose a drug like pradaxa for this profile. The main side effect of such drugs is unexpected bleeding in brain, gut, intestine or other sites. This risk is especially high for patients taking other blood thinners, who have kidney failure and those who have history of bleeding from gut. Beside some concerns were raised about increase risk of heart attacks (but incidence was quite low) and advisory was issued about avoiding this drug in patients who have multiple risk factors for heart attack (like diabetes, smoking. high cholesterol, high BP, etc.).
5. It should be used in patients in whom it is clearly required and those who do not have high risk factors for side effects. Hence major benefit is prevention of clot in heart & its consequences and major side effect is bleeding.
Hope this helps. Feel free to discuss further.
Sukhvinder XXXXXXX
Above answer was peer-reviewed by
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