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Paul Cirielli, 65, of Montvale, N. Paul Cirielli of Montvale, N. And Arlene Geise of Miami has stopped taking blood thinners after a bout of severe gastrointestinal bleeding sent her to the hospital. All three senior citizens were advised to take the drugs after periodic episodes of the abnormal heart rhythm called atrial fibrillation, meaning they were at higher risk of having a clot travel from the heart to the brain - a stroke. All are taking one of several newer anticlotting drugs and have become acquainted with a balancing act that millions face.

On one hand, a stroke can be incapacitating or fatal, and blood thinners, formally called anticoagulants, significantly reduce the risk. On the other hand, the drugs cause bleeding more easily. That is an inconvenience in most cases, and physicians say it is well worth it, given the upside of protecting the brain. Bleeding can be managed, said Charles Paraboschi, a cardiologist at St.

Mary Medical Center in Langhorne. But a stroke? Still, each year a few patients out of every end up with major bleeding, such as Geise, In , she started taking the anticoagulant Xarelto, marketed in the U. All was good until last fall. Geise said she felt ill for several weeks, and one night in November, she awoke to find she was bleeding from her rectum.

She went to the emergency room and spent three days in the hospital, followed by two more days of returning for tests. Physicians blamed Xarelto and told her to quit, she said. That drug - approved by the Food and Drug Administration in July for patients with atrial fibrillation not caused by a heart-valve problem - is one of four newer anticoagulants. All are designed to compete with warfarin, a drug developed more than 60 years ago. Patients on that medicine must have their blood tested every few weeks to make sure the drug is present at a safe and effective level.

The makers of the novel drugs tout that patients who take them need not undergo any such test. And studies indicate the new drugs are at least as effective at preventing strokes and are less likely to cause intracranial bleeding. Yet gastrointestinal bleeding, such as Geise suffered, may be more likely.

Some clinicians and patients are concerned the newer drugs do not have a "reversal agent" - an antidote that would stop bleeding in an emergency - but several such drugs are in development. A study of one such drug, aimed at reversing the effects of Pradaxa, is being led by Pennsylvania Hospital's Charles Pollack, professor of emergency medicine at the University of Pennsylvania's Perelman School of Medicine.

Both studies published in the New England Journal of Medicine this month showed new blood thinners apixaban and dabigatran, also known as Pradaxa, were effective in protecting long-term against blood clots in the legs and lungs It's significant because many patients can't or won't stay on warfarin for longer than six months because it's a difficult-to-take drug that requires close monitoring and significant changes to diet. Dabigatran "is very convenient and that makes it attractive to give to a patient who otherwise would consider stopping treatment," said Dr.

Sam Schulman, lead author of the dabigatran study. Schulman is director of the clinical thromboembolism program at Hamilton Health Sciences and a professor at McMaster University. The downside is that the new drugs are significantly more expensive than warfarin. Hamilton researchers have been doing a number of studies comparing dabigatran and warfarin to extend its approved uses as well as fend off safety concerns raised by American doctors.

The U. Food and Drug Administration recently concluded an investigation into the drug that found bleeding rates were no higher than warfarin and the benefits were worth the safety risks.

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Sports betting lines apixaban Klug, 66, the surfer, has been on Xarelto since spring But many experts now suspect that the cases were coincidental. Inshe started taking the anticoagulant Xarelto, marketed in the U. For now, he'll take the latter. Yet gastrointestinal bleeding, such as Geise suffered, may be more likely. Geise said she felt ill for several weeks, and one night in November, she awoke to find she was bleeding from her rectum. Dabigatran "is very convenient and that makes it attractive to give to a patient who otherwise would consider stopping treatment," said Dr.

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