Article: Which drug, when?


Nice, France – At Cardiostim 2012, two experts working on new European guidelines on stroke prevention in atrial-fibrillation patients gave a broad preview of how those guidelines will address the questions created by the introduction of several new anticoagulants.

“In the coming years, we won’t have to decide who needs anticoagulant therapy—because that’s practically all patients with atrial fibrillation—but we will suddenly have to pick which anticoagulant to use,” Dr Paulus Kirchhof (University of Birmingham, UK) explained during a presentation entitled, “What should the new guideline revisions on stroke prevention look like?”

For a long time, vitamin-K antagonists, especially warfarin, were the only option for mitigating stroke risk in patients with atrial fibrillation, until the Randomized Evaluation of Long-Term Anticoagulation Therapy (RE-LY) trial showed that dabigatran (Boehringer Ingelheim, Pradaxa) could reduce ischemic and hemorrhagic stroke more effectively than warfarin with the same risk of bleeding. RE-LY was the “game changer,” according to Kirchhof, and since then, rivaroxaban (Xarelto, Bayer/Johnson & Johnson) and apixaban (Eliquis, Pfizer/Bristol-Myers Squibb), both direct factor Xa inhibitors, have also emerged as warfarin alternatives.

Kirchhof couldn’t reveal exactly how the European guidelines will treat the new agents but indicated that newer agents will be considered preferable to warfarin for most AF patients. “New anticoagulants give us a way to treat those patients who are untreated so far. That is the most prominent benefit. In terms of safety, I would think people would prefer the new anticoagulants over vitamin-K antagonists, because even in patients in RE-LY who were well controlled, the rare fatal bleed is just less likely on the new anticoagulants than on vitamin-K antagonists.”

Read the full article here:

Lip G and Kirchof P. Stroke prevention in atrial fibrillation: State of the art and new concepts. Cardiostim 2012; June 14, 2012; Nice, France.