A new advisory, which is published online and will be appearing in the journal Stroke’s October edition, has been issued addressing the best methods of stroke prevention for AF patients by the American Heart Association/American Stroke Association, which covers newer oral antithrombotic agents meant to prevent strokes for patients who have nonvalvular atrial fibrillation (AF).
This recent update is recommending that patients can use the popular Warfarin and Dabigatran (which are both already used for this purpose) and Apixaban, which is relatively new. The groups do not recommend Multaq.
“This update talks about the addition of several new agents that appear to be as good if not better than Warfarin in terms of preventing embolic stroke and preventing hemorrhage,” said Karen L. Furie, MD, neurologist-in-chief at Rhode Island Hospital, and chair and professor of neurology at Alpert Medical School at Brown University, Providence.
Furie co-chaired the writing committee for the new advisory, along with Larry B. Goldstein, MD, director of the Duke Stroke Center at Duke University Medical Center in Durham, North Carolina.
“They have a better safety profile than Warfarin and are at least as efficacious, and that is a significant improvement in our armamentarium,” Furie told Medscape Medical News. The new agents offer a much simpler approach to management because they do not require regular international normalized ratio (INR) testing, as Warfarin does, and they are dosed once or twice daily, “so it really represents a major advance in trying to prevent stroke,” she notes.
The first drug to be approved as an alternative to Warfarin was Dabigatran (October 2012); Rivaroxaban was approved in November 2011 as an alternate to Warfarin and Apixaban is expected to be approved soon. One drug that was left off the list was Multaq, which is made by Sanofi-Aventis. Multaq is an anticoagulant medication that has been linked to liver failure and worsening of the heart condition, and because of this, the drug is only recommended for use if other medications for AF treatment fails.
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