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Kaitlyn Dmyterko, staff writer

Ch-ch-ch-ch-Changes (Turn and face the strange),” sings English rocker David Bowie. Just like Bowie sings, changes occur in the medical industry daily. New focuses on disease management and alternative treatments and medications leave cardiologists wondering: Should we make a change or should care stay the same?

This week, a modeled analysis published in the Annals of Internal Medicine revealed that a fixed dose of the recently FDA-approved Pradaxa may be a cost-effective alternative to warfarin therapy in elderly atrial fibrillation patients.

The researchers found that a 150 mg dose of Pradaxa was associated with a better quality of life and was reasonably cost effective compared with a 110 mg dose. Additionally, the 150 mg dose was estimated to prevent almost 1,000 intracranial hemorrhages and 600 strokes compared to the estimates for warfarin.

The researchers deemed the drug a good alternative for patients at a low-risk for stroke and intracranial hemorrhage.

Additionally, a study in Radiology indicated that MRI may effectively determine the time of stroke onset, extending thrombolysis treatment to 25 percent more patients admitted for strokes.

At present, many patients who would benefit from thrombolysis are ineligible because time of stroke onset is not known. The study showed that a particular MRI algorithm detected time to stroke onset with over 90 percent accuracy.

Lastly, researchers from McGill University found that using gait speed as a clinical risk assessment tool can better predict mortality and morbidity in subsets of elderly cardiac surgery patients.

A slower gait speed can predict patients who are more likely to experience major CV events or who will most likely have longer hospital stays or need to be discharged to a hospital for continued care. Additionally, assessing gait speed is a low-cost tool that can better predict mortality.

The aforementioned alternatives that have evolved in this week’s news offer tempting medical alternatives to better assess and predict mortality and stroke onset. Additionally, the approval of Pradaxa by the FDA could leave doctors wondering whether switching AF patients off Coumadin and on to Pradaxa is a viable, cost-effective alternative of care.

How do you intend to incorporate Pradaxa into your practice? Let us know.

Alternatives pop-up often in the medical field leaving physicians to ponder the pros and cons of each treatment—device or medication—with the hope of ultimately giving them access to a better standard of care.

Kaitlyn Dmyterko