According to the newest update in AF guidelines posted by the Canadian Cardiovascular Society, newer anticoagulant medications like Rivaroxaban and Apixaban is preferable over older anticoagulant medications like Warfarin and Multaq.
The updated guidelines are meant to be reflective of recent research findings that have come out in the last year. The new update, which was published in the March 2012 issue of the Canadian Journal of Cardiology, basically just makes an addition to the previous AF guidelines that were published in 2010. The lead author of this new update is Dr. Allan Skanes, University of Western Ontario, London, who explained to Heartwire that the guidelines committee decided on the update because a great deal of information was made available about different anticoagulant medications in 2011.
The drugs Rivaroxaban and Apixaban has been getting a lot of attention lately as a better medication than Warfarin for the prevention of strokes in AF patients. Meanwhile, the cancelled PALLAS study of Multaq (dronaderone) over serious side effects (liver failure, worsening heart condition and death) eventually caused the FDA to advise doctors against prescribing the drug unless all other medications don’t work.
The newest update to the AF guidelines specifically states: “When oral anticoagulant therapy is indicated, most patients should receive Dabigatran, Rivaroxaban, or Apixaban (once approved by health Canada), in preference to Warfarin (conditional recommendation, high-quality evidence).”
“The 2010 guidelines made a soft recommendation for Dabigatran over Warfarin, and we have now extended this to Rivaroxaban and Apixaban,” Skanes says.
While Apixaban is not currently available in Canada for this purpose, Skanes is confident that it will soon be approved.
“We are nudging toward the new agents,” he adds. “This is because two of them have been shown superior to Warfarin in reducing stroke, and across the board they all reduce intracranial hemorrhage, which is the worst problem with Warfarin.”
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