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  • The ACCP Guidelines June 2008: Dabigatran (Pradaxa) A direct thrombin inhibitor, is similar to ximelagatran in that it is the prodrug of the orally bioavailable dabigatran etexilate.[20] Dabigatran binds directly to thrombin and prevents the cleavage of fibrinogen to fibrin, an essential step in thrombus formation. Dabigatran inhibits both fibrin-bound thrombin as well as circulating fibrin. Rivaroxaban (Xarelto) Offers significant management advantages over warfarin. It does not require laboratory monitoring, is dosed once a day, and to date, no drug-drug or drug-diet interactions have been identified. Nor is rovaroxaban associated with the same adverse hepatic effects that were the demise of ximlelagatran 4 years ago. The advantages of rivaroxaban are related to the drug's high selectivity for factor Xa.
  • RIVAROXABAN: Factor Xa Inhibitor - Acute Coronary Syndromes (ACS), stoke prevention, instead of warfarin (post surgery)

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  • THE INTERACTIONS OF HERBS AND DRUGS: According to one recent literature review, it was suggested that patients try to limit their vitamin K intake from their diet to 65?80 micrograms. Vitamin K is produced by intestinal bacteria; use of antibiotics that inhibit intestinal bacteria can also change the vitamin K content of the patient?s blood. Teas, pills, and other forms of herbal preparations generally have low levels of vitamin K, due to the relatively small amount of leafy tops (the main source of this vitamin) that are consumed. Still, many herbs are reputed to have anticoagulant properties that were investigated because of the importance of anticoagulatio n therapy ... In particular, the most commonly used Chinese herb for treating blood stasis in modern practice is salvia. It has been reported that salvia may enhance the warfarin effects and may cause significant changes in blood properties. Tang-kuei was also mentioned.

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