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March 12, 2014
New Guideline: Use Anticoagulants in Nonvalvular Atrial Fibrillation Patients
Minneapolis—Patients diagnosed with nonvalvular atrial fibrillation (NVAF) should be prescribed oral anticoagulants, according to the American Academy of Neurology, which points out that there are better blood thinner options available now than there have been in the past. The new guideline, updated for the first time since 2008, appeared recently in the journal Neurology. It suggests that the new novel anticoagulants—dabigatran, rivaroxaban and apixaban—are at least as effective, if not more so, than the established treatment with warfarin. The newer drugs have a lower risk of bleeding in the brain and also don’t require frequent blood testing like warfarin, the authors add. The guideline, which has been endorsed by the World Stroke Organization, further notes: • Triflusal plus acenocoumarol is likely more effective than acenocoumarol alone in reducing stroke risk. • Clopidogrel plus aspirin is probably less effective than warfarin in preventing stroke and has a lower risk of intracranial bleeding. • Clopidogrel plus aspirin as compared with aspirin alone probably reduces stroke risk but increases the risk of major hemorrhage. • Apixaban is likely more effective than aspirin for decreasing stroke risk and has a bleeding risk similar to that of aspirin. “Clinicians might obtain outpatient cardiac rhythm studies in patients with cryptogenic stroke to identify patients with occult NVAF (Level C) and should routinely offer anticoagulation to patients with NVAF and a history of TIA/stroke (Level B),” according to the guideline, which ranks its recommendations. “Specific patient considerations will inform anticoagulant selection in patients with NVAF judged to need anticoagulation.” Anticoagulation is especially important for patients who have had a stroke or transient ischemic attack in the past, the guideline emphasizes. Irregular heartbeat is a major risk factor for stroke, which affects about one in 20 people with untreated atrial fibrillation. “The World Health Organization has determined that atrial fibrillation is nearing epidemic proportions, affecting 0.5 percent of the population worldwide,” said guideline lead author Antonio Culebras, MD, of SUNY Upstate Medical University in Syracuse, NY. The guideline notes that the new anticoagulants provide more options to patients who often go untreated, such as the elderly, those with mild dementia, and those at moderate risk of falls, as well as those whose health status was long thought to be a barrier to use. “Of course, doctors will need to consider the individual patient's situation in making a decision whether or not to use anticoagulants, and which one to use, as the risks and benefits can vary for each person,” Culebras said. |
U.S. Pharmacist Social Connect
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