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Is Pradaxa Prescribed To People Who Have Atrial Fibrillation?

Posted on Fri, 9 Nov 2018

Question: Is Pradaxa prescribed to people who have Atrial Fibrillation?

Answered by Dr. Ilir Sharka (9 minutes later)

Brief Answer:
I would explain as follows:

Detailed Answer:
Hello!

Welcome and thank you for asking on Ask a Doctor service!

Regarding your concern, I would explain that this is a blood thinners ( oral anticoagulant) used commonly in patients with atrial fibrillation in order to prevent possible embolic events, especially when other comorbidities like arterial hypertension or stroke are present.

Hope you will find this answer helpful!

I remain at your disposal for any further questions whenever you need!

Kind regards,

Dr.Ilir Sharka, Cardiologist

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Follow up: Dr. Ilir Sharka (51 minutes later)

This is very difficult for me to describe. My grandmother was prescribed pradaxa 75mg. A voicemail was left for her from her doctor that he increased the amount to 110mg. It wouldn't be ready for pick-up from the pharmacy for a few days. The day before it would have been ready for pick-up we had to call 911 because of difficulty breathing. Turns out there is fluid in or around her lungs as well as fluid in or around her heart. The hospital knew of this fluid from a month prior. Why did they leave it there or not discuss it with her or us? So she was in the hospital for 2 days, the second day they drained the fluid around lungs, nearly a liter. An hour later they discharged her. After getting back home she was having the same symptoms. She went back to the hospital and now all of a sudden has congestive heart failure and renal failure. Shouldn't that have been found before? Was not being on a high enough dosage of Pradaxa putting her at risk for these problems to get worse?

Follow up: Dr. Ilir Sharka (2 hours later)

correction: acute congestive heart failure and acute renal failure

Answered by Dr. Ilir Sharka (1 hour later)

Brief Answer:
I would explain as follows:

Detailed Answer:
Hello again!

I passed carefully through your question and would explain that heart failure is a clinical syndrome, which can precipitate from many risk factors.

I don't think that her situation has been aggravated by the increase in the dose of Pradaxa.

Anyway, in renal failure, it is recommended a decrease in the dose of Pradaxa to 75mg daily. This is done in order to avoid possible overdose of the drug (as there is a reduction in renal excretion) and thus reduce the risk of bleeding.

The pleural effusion, could be related to heart failure exacerbation (it is a clinical sign of the disorder).

The renal failure is another disorder associated to heart failure (also called cardio-renal syndrome).

In such case hospitalization in the ICU is necessary and diuretics are needed to improve the situation.

Hope to have been helpful!

Wishing good health,

Dr. Ilir Sharka, Cardiologist

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Ilir Sharka (42 minutes later)

Would you remove a liter from a patient and discharge them shortly thereafter?

Answered by Dr. Ilir Sharka (4 hours later)

Brief Answer:
I would explain as follows:

Detailed Answer:
Hello again!

I understand your concern and would be the time of hospitalization depends on the diagnosis (cause of pleural effusion).

But, maybe I would wait a couple of days and see if the situation would be stable.

Anyway, I would like to directly review his performed tests ( if you could upload them),in order to be able to give a more professional opinion.

Hope you will find this answer helpful!

Wishing good health,

Dr.Iliri

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Ilir Sharka (4 hours later)

I will attempt to get info on the tests performed and a cause. You mentioned bleeding if there was an overdose of Pradaxa. Would this be RBC in the urine?

Answered by Dr. Ilir Sharka (2 minutes later)

Brief Answer:
I remain at your disposal for any further questions.

Detailed Answer:
Hello again!

Yes, red blood cells in the urine could be related to pradaxa.

But they could also be related to an urinary tract infection.

So, we can not distinguish only based on this finding.

I remain at your disposal for any further questions whenever you need!

Regards,

Dr.Iliri

Above answer was peer-reviewed by : Dr. Raju A.T

Follow up: Dr. Ilir Sharka (23 minutes later)

Did you see the screenshot I uploaded or shared with you of the urinalysis? The culture showed no UTI.

Answered by Dr. Ilir Sharka (9 hours later)

Brief Answer:
My opinion as follows:

Detailed Answer:
Hello again!

I reviewed carefully the urine test report and would explain that it could indicate urinary bleeding, possibly related to Pradaxa.

But this is not the cause of renal failure or heart failure.

So, I don't think that the high dose of Pradaxa is the real cause of her worsening.

Hope you will find this information helpful!

Wishing good health,

Dr.Iliri

Above answer was peer-reviewed by : Dr. Kampana

Follow up: Dr. Ilir Sharka (31 minutes later)

They keep getting ready to discharge her and then a call from a nurse that she will be staying another night. I don't understand this hospital and its doctors. No one to speak to or get an answer from. This photo of the monitor is the only info I have.

✓ IMG_0000_0000.jpg has been uploaded.

Answered by Dr. Ilir Sharka (1 hour later)

Brief Answer:
I would explain as follows:

Detailed Answer:
Hello again!

I carefully reviewed your uploaded image and would explain that her vital parameters seem to be within the normal ranges:

- respiration frequency 26/min
- Heart rate XXXXXXX 150 bpm, min 50bpm (normal fluctuations)
- oxygen saturation optimal 99%
- blood pressure values 160/90 ( a little high now).

What about her renal function tests and cardiac ultrasound report? Can you upload them for a second opinion?

I remain at your disposal for any further questions!

Regards,

Dr. Iliri

Note: For further queries related to coronary artery disease and prevention, click here.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar