Pradaxa update:
If your doctor recommends this instead of warfarin, make sure he knows what he's talking about!! The minimum dose required for the equivalent effect of warfarin with INR between 2-3 is 220mg per day. 300mg per day is more effective than warfarin but has a higher bleeding risk.
My doctor gave me a dose that was apparently "lower than a pediatric dose" according to the ER dr I saw when my OTHER leg (the one the DVT was not diagnosed in) started clotting. The problem is NOT that Pradaxa isn't effective at the correct dose; rather, it's that Canadian hospitals and doctors are not prepared to deal with it. Until Health Canada approves it and hospitals are able to do the ecarin clotting time test in their labs, there is no accurate way for a doctor to know how thin your blood is.
In my case, the ER dr wouldn't even give me heparin/delta-parin as he was nervous about causing hemmoraging. A hematologist had to be consulted so that I could be switched back to the warfarin.
The aPTT is a rough estimate of Pradaxa activity but many doctors do not want to rely on it as it is unpredictable at best. If you've read other threads about Pradaxa, you'll know that one of the major concerns is that it is not reversible. It has a half life of 12-17 hours but can then stay in your bloodstream for 24-48 hours so if you get into an accident or require emergency surgery, NOTHING can be done to stop the excessive bleeding and hospitals have not yet come up with emergency protocols to deal with this situation. It appears right now the only options available are blood transfusions to replace lost blood or dialysis to remove Pradaxa from your system.
I don't want to be totally negative about Pradaxa; I had virtually no side-effects on it in comparison to warfarin and IF Health Canada approves it and comes up with educational material for doctors and hospitals, I would switch to it.
As for my doctor, I will never see him again. I discovered that in addition to his negligence in prescribing me such a low dose of Pradaxa and telling me he didn't need to see me or test my blood for 6 months, he was also trying to get my INR below 2 while I was on warfarin. Pretty scary stuff!
The one thing I have learned is that I need to take total control over my healthcare and I can't be afraid to question my doctor's advice. Doctors see thousands of patients and if you don't advocate for yourself, you might fall through the cracks. If something doesn't feel right or sound right, speak up! Your life could depend on it.