How does one safely discontinue Pradaxa?

Just curious - I am looking forward to getting off Pradaxa, as it makes me quite sick. How exactly is one taken off? I have read in some places that abrupt discontinuation results in a state of hypercoagulation, which in itself can precipitate a stroke

Its a "Black Box Warning" from FDA. My EP says there is similar risks with discontinuing any of the NOAC's, its just worse with Pradaxa. I decided to taper off of these drugs when it is time to get off of them, but there may not be any Medical Literature supporting this idea.

[www.accessdata.fda.gov]

I've been taken off it (and Eliquis and warfarin) several of times. You just stop taking it. There is no taper procedure.

I don't know where this legend comes from about needing to taper comes from but I've seen no credible evidence of any sort of rebound effect. The black box warning isn't about hypercoagulability. It's simply a warning about stopping the drug without adequate coverage with something else. So if you, for example, took your last Pradaxa on Monday night and then took your first Eliquis on Tuesday morning, you'd be fine. The black box warning is saying don't stop the Pradaxa on Monday and then wait a week to take something else.

Just found a BMJ study - 2012 - concluding that there was a significant risk of rebound effect strokes, especially in people going off because of bleeds, and especially during the first thirty days after abrupt discontinuation. . Will post the citation in a bit.

Thorne, K. M., Dee, S., & Jayathissa, S. (2012). Thrombotic events after discontinuing dabigatran: rebound or resumption?. Bmj, 345, e4469.

Yes, I've seen that study, and that's why I said I've seen no credible evidence of a rebound effect. That study is full of problems and there have been no further studies I'm aware of that support it. It's 8 years old and nobody has replicated it, which is usually a sign they don't think it's worth bothering. Patients start and stop anticoagulants cold every day without problem. Needing to taper is an urban legend as best I can tell.

Your plan is to switch from Pradaxa to something else, right? If so, then tapering just isn't an issue for you. You're going from Pradaxa to something else immediately, right? If so, then that study and the black box warning are simply irrelevant for you. You'll be fine.

Göndör, G., & Stöllberger, C. (2017). Pulmonary embolism four days after interruption of therapy with rivaroxaban. Hämostaseologie, 37(04), 302-306.

"We conclude from this observation that there is an urgent need to clarify the rate of a rivaroxaban rebound phenomenon, manifesting as arterial embolism and stroke as well as venous thromboembolism. Furthermore, it has to be assessed if rebound phenomena also exist for other NOACs like dabigatran, apixaban and edoxaban. For that purpose, the data of the large randomized trials and registries investigating patients with atrial fibrillation or venous thromboembolism should be analysed. There is a need to develop recommendations for situations in which NOAC-therapy has to be interrupted or ceased. At present it remains uncertain if low-molecularweight heparin in therapeutic doses has to be administered for several days until the hypercoagulable state has resolved."

That's just a case study. It was a single patient who just underwent surgery and also happened to be a CHADS 4. Also, he was on Xarelto, not Pradaxa. There's no evidence of a rebound effect in that paper so the author is purely speculating.

I have stopped Pradaxa,Xarelto and Eliquis cold turkey. NEVER had a single issue.

There is more evidence that stopping a NOAC abruptly poses a health risk, compared to tapering off of these Drugs. Where is the evidence that Tapering off causes any harm? Same thing with Tapering off of Corticosteriods like Prednisone.

Just doing my research -

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The Anti-Fib
There is more evidence that stopping a NOAC abruptly poses a health risk, compared to tapering off of these Drugs.

I'd like to see that evidence.

Me too - I have been looking