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Xarelto Here We Go Again

In recent years, various players in the pharmaceutical industry have introduced a new line of anticoagulant drugs (popularly known as “blood thinners,” although this is not quite accurate – read on) that have promised to make life much easier for physicians who treat patients at risk for stroke. A stroke of course is the result of a blood clot that cuts off blood supply to the brain, and can result in permanent injury and even death. 

For decades, the standard medication used to prevent clotting was a form of rat poison called warfarin, sold under the brand name Coumadin. It is derived from a substance known as coumarin, a biochemical found in woodruff and sweet clover (which gives these plants their pleasant odor). Warfarin is a “Vitamin K antagonist,” meaning that it literally inhibits the action of Vitamin K – which acts to form blood clots. 

The new generation of anticoagulant drugs like Xarelto are known as “direct Factor Xa ('Ten-A') inhibitors.”  Instead of acting upon Vitamin K, it prevents the action of an enzyme produced in the liver that is also necessary for the clotting process.

The danger in both types of drugs lies in the fact that they inhibit all blood clotting – including that which occurs when a patient suffers a surface wound or subcutaneous injury that results in a bruise (which is bleeding under the skin). It is possible for a patient on one of these medications to bleed to death. 

The drawback of Warfarin is that it requires constant patient monitoring, due to the number of potential interactions with other medications as well as certain foods (such as leafy greens, which contain high levels of Vitamin K). However, hemorrhaging can be controlled relatively easily by giving the patient high doses of Vitamin K.

The touted advantage of the new generation of Factor Xa inhibitors like Xarelto is that there are relatively few interactions – and therefore, less (costly) patient monitoring is required. However, if uncontrolled bleeding occurs, there is no way to stop it – other than to put the patient on emergency dialysis in order to get the drug out of the system as quickly as possible.  Even a slight bump on the head can be fatal. 

This could cost the manufacturer billions of dollars in sales as well as lawsuits as the effects of Xarelto become increasingly aware of the dangers of this particular medication. Some of the companies involved in the marketing and sales of the drug have already been hit with numerous lawsuits over other  dangerous products and devices, and this might prove to be yet one more nail in the coffin of a system and an industry virtually focused entirely on profits and the bottom line – regardless of the human cost.

Unfortunately, since these global corporate behemoths are so huge (dare we say, “too big to fail?”), there are a great many nails yet to be driven.

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