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Published on 10 February 2012

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New drugs to replace warfarin for stroke prevention

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A new generation of easy-to-use blood-thinning drugs is likely to replace Coumadin in the next few years for patients with irregular heartbeats who are at risk of stroke, according to research published in the journal, Expert Reviews.

Unlike Coumadin, the new drugs do not require patients to come in to the clinic on a regular basis to check the dose. Nor do the drugs require extensive dietary restrictions.

The new drugs include rivaroxaban (Xarelto®), dabigatran etexilate (Pradaxa®) and apixaban (Eliquis®).

They do not share the disadvantages of Coumadin, and may provide equal or superior prevention against clots, according to lead author Sarkis Morales-Vidal and colleagues from the Department of Neurology, Loyola University, USA.

Coumadin’s generic name is warfarin, which for more than 30 years had been the only anticoagulant for primary and secondary stroke prevention in patients with atrial fibrillation.

But the European Medicines Agency and US Food and Drug Administration (FDA) recently approved dabigatran and rivaroxaban to reduce the risk of stroke and blood clots in patients with atrial fibrillation that is not caused by a heart valve problem.

The FDA is considering an application to approve apixaban for the same use.

Coumadin must be carefully monitored. If the dose is too high, a patient could experience excessive bruising and be at higher risk for brain haemorrhages. If the dose is too low, the drug would be ineffective in preventing blood clots.

Patients typically must come in at least once a month for a blood test to determine whether the dose needs to be adjusted. Some patients have to come in as often as twice a week. Coumadin patients also must restrict their diets.

Disadvantages of the new medications include the limited clinical experience and lack of antidotes. The newer drugs are more expensive than Coumadin, but reduce the cost of patient monitoring and blood testing.

Dabigatran is an effective alternative to Coumadin for stroke prevention in patients with non-valvular atrial fibrillation. Rivaroxaban is another promising alternative for those patients.

Apixaban appears to be better than aspirin for stroke prevention in atrial fibrillation patients who are not candidates for Coumadin therapy, Morales and colleagues wrote.

The authors predict that within the next few years, the new drugs will likely replace Coumadin for long-term anticoagulation in selective patients with non-valvular atrial fibrillation.

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