Research Paper on Stroke: A Leading Cause of Death & Disability in US

Introduction

Stroke is a disease that affects the arteries within the brain and those leading to the brain. According to the America Stroke Association, stroke is the number five leading cause of death and the leading cause of disability in the United States (Alberts, Bernstein, Naccarelli, & Garcia, 2012). The condition occurs when there is either a blockage or rupture of a blood vessel carrying nutrients and oxygen to the brain. This lead to the death of part of the brain that cannot get the oxygen and blood, and the brain cells. There is an array of medical interventions that can be administered or prescribed by doctors to stroke patients. Among them include the use of Coumadin and that of Pradaxa, which in this PICOT case will form the intervention and Comparison, respectively. The patient is suffering from stroke, and the outcome is to experience fewer reoccurrence in stroke. Lastly, the time is within five years.

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Background of the Problem

There are various interventions for patients who suffer from a stroke. In this case, the two interventions discussed are Coumadin, which is compared to Pradaxa. These interventions aim to ensure that the patients experience fewer reoccurrence of strokes within five years when administered with these drugs. The intervention for this problem has been the use of Coumadin for decades. For the first time in almost half a century, the first new oral anticoagulant (Pradaxa) has been introduced. The use of Coumadin has been the best method for decades, but the drug is referred to as to be a kind of Goldilocks (Alberts et al., 2012). One needs to undergo several blood tests to ensure that the amount of the drug is not too high in their blood, as this could lead to lots of bleeding or is not too low as this could lead to having a stroke. Besides, one also needs to pay close attention to their diet because if they take a sudden meal having high levels of vitamin K, then this could counteract with the Coumadin (King, Szarlej, & Rincon, 2015).

PICOT Question

The PICOT question: Do patients suffering from a stroke who take Coumadin vs. Pradaxa experience fewer reoccurrence in strokes within five years?

In this PICOT question, all the elements of PICOT are included. The patients who are suffering from stroke, an intervention, which is the use of Coumadin, Comparison, which is Pradaxa, outcome which is to experience fewer recurrence of stroke, and time which is within five years period. The use of Coumadin in patients suffering from stroke has been there for a long time, and it is a potent medication for the condition. Coumadin can prevent the abnormal formation of a blood clot in the body. According to Xian et al. (2015), 88% of stroke survivors were treated with Coumadin. According to this source, patients treated with Coumadin had more time at home as compared to institutional care during the two years of discharge. That implies that the use of Coumadin as an intervention for stroke leads to a fewer reoccurrence of stroke within five years.

For Pradaxa, which is used for the Comparison, its introduction got many doctors excited. This is because it got a green light after several attempts with Coumadin in patients with atrial fibrillation irregular heartbeat. Besides causing fewer bleeding side effects, Pradaxa is equally effective as Coumadin for preventing blood clots that cause a stroke. The use of Pradaxa also does not require frequent blood tests, like is the case with Coumadin (LeWine, 2014). However, just like Coumadin, Pradaxa is also affected by food, and this implies that the patients have to take great care of what they eat. The benefits of Coumadin and Pradaxa are equivalent regardless of whether they are naive to Coumadin or not, and regardless of whether they had or did not have a history of prior stroke or brief ischemic attack.

Conclusion

The results of this PICOT report highlights the availability of clear evidence to compare the efficacy and safety of using Coumadin and Pradaxa as intervention methods in patients with stroke. Looking at the two drugs, there are pros and cons associated with both of them, but from the research and analysis done, one must be better than the other in the long run. Coumadin has been in existence for a long time, and it only until recently that Pradaxa came into play in the clinical intervention of stroke. Both two drugs reduce the reoccurrence of stroke in patients within five years of their administrations. Still, there are adverse side effects associated with Coumadin, which makes Pradaxa better in Comparison. For Coumadin, one needs to undergo several blood tests to ensure that the amount of the drug is not too high in their blood, as this could lead to lots of bleeding. Besides, if the amounts are too low, then it could also lead to stroke. From this, we can argue that the use of Pradaxa is an appropriate inpatient with stroke than that of Coumadin.

References

Alberts, M. J., Bernstein, R. A., Naccarelli, G. V., & Garcia, D. A. (2012). Using dabigatran in patients with stroke: a practical guide for clinicians. Stroke, 43(1), 271-279. https://www.ahajournals.org/doi/10.1161/STROKEAHA.111.622498

King, A. E., Szarlej, D. K., & Rincon, F. (2015). Dabigatran-associated intracranial hemorrhage: literature review and institutional experience. The Neurohospitalist, 5(4), 234-244. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4572378/

LeWine H. (2014). Bleeding risk from new blood thinner Pradaxa higher than first reported. Harvard Health Publishing. Harvard Medical School. https://www.health.harvard.edu/blog/bleeding-risk-new-blood-thinner-pradaxa-higher-first-reported-201411057501

Xian, Y., Wu, J., O'Brien, E. C., Fonarow, G. C., Olson, D. M., Schwamm, L. H., ... & Lindholm, B. (2015). Real world effectiveness of warfarin among ischemic stroke patients with atrial fibrillation: observational analysis from Patient-Centered Research into Outcomes Stroke Patients Prefer and Effectiveness Research (PROSPER) study. bmj, 351, h3786. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4521370/