Hey, that's my drug!

Every day I take a Xarelto pill. Xarelto is a blood thinner, which decreases the risk of blood clots, and since I had a clot not long after I began chemotherapy, I need the blood thinner, which reduces the degree to which blood coagulates.

There are three possible blood thinners, Xarelto, Lovenox and Warfarin (actually, I understand from a friend that these aren't the only blood thinners, but they're the ones we heard about). Xarelto, I believe, is the newest, having only passed its clinical trial a few years ago. Lovenox, from what I understand, is a considerably less attractive proposition on a day-to-day basis, because it has to be injected, and twice a week. Warfarin comes in a pill, but comes with significant dietary restrictions. (The first version of this post in effect combined Lovenox and Warfarin into one drug, but with help from Teresa and a commenter, I've revised it to get it right.)  The advantage of Warfarin is that if something happens to you that causes a lot of bleeding – a traffic accident, for instance – there’s an antidote to Warfarin that will restore your blood’s ability to coagulate, hence stopping the bleeding, very quickly. With Xarelto, there’s no antidote, so it takes 24 hours for its effects to wear off. I’m planning to avoid traffic accidents.

But it turns out that there was a problem with the clinical trial that found Xarelto as effective as Warfarin. The problem, as I understand it, was that the blood testing done on the patients taking Warfarin was done with a device whose accuracy is very questionable. Here’s the New York Times’ account of the controversy. Perhaps the most startling detail: one of the co-chairs of the clinical trial has been nominated by President Obama to become the chief of the Food and Drug Administration.  (The FDA’s role in regulating cancer medications is a complex topic, maybe for another day.)

My wife and I discussed this clinical trial with the Sloan-Kettering physician who monitors my blood, and she assured us that the doctors there have independently concluded that Xarelto is an appropriate drug to use. That confirms what a German cardiologist quoted by the Times said: “The real world has already made the case for this drug.” And it certainly suits us: if Xarelto went off the market, we’d have to turn to one of the other drugs, neither of which seems very attractive. 

The Sloan-Kettering doctor added that it was unfortunate that news stories like this one get lay people needlessly alarmed. That may be so, but Xarelto certainly can’t complain about it, since Xarelto is one of those drugs that advertises directly to lay people on TV. This is the first time I’ve taken one of these heavily-advertised drugs, and my feeling so far is that it’s better if your medicines are not in the news!