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(Reuters Health) – Patients with atrial fibrillation, a common heart rhythm disorder, should take new anticoagulants to prevent stroke instead of the old warfarin drug reserve, US doctors recommend.
Patients with atrial fibrillation have up to seven times more risk of stroke than people without this disorder.
"Strokes due to atrial fibrillation tend to be quite serious," said Dr. Craig January of the University of Wisconsin-Madison, who helped write the new guidelines published in Circulation.
In atrial fibrillation, electrical impulses in the upper chambers of the heart are chaotic, causing the heart muscle to tremble rather than contract normally. As a result, blood does not flow into the heart too. This can lead to the formation of clots which can then cross the arteries to the brain.
Although doctors have long recommended anticoagulants to prevent stroke in patients with atrial fibrillation, many people who need it do not take it. Warfarin, which was once the drug of choice for this purpose, carries a risk of severe bleeding and is impractical; it requires frequent laboratory tests and checkups to ensure that patients receive the correct dose.
Instead of warfarin, the new guidelines advise most people with atrial fibrillation to take newer anticoagulants, non-vitamin K oral anticoagulants (NACOs). NOACs include dabigatran, rivaroxaban, apixaban and edoxaban.
"Clinical trials have suggested that NOACs have a lower risk of bleeding compared to warfarin, and at least some of them could also be slightly better at preventing blood clots (obstruction of blood vessels) and accidents." cerebral vascular diseases, "said January by email.
Another potential benefit of NOACs is that their effects can be reversed more easily than warfarin if patients develop heavy bleeding or require emergency surgery. The latest drugs, called inversion agents, can act within hours to stop the anticoagulant activity of NOACs, while warfarin can take a day or more to reverse the trend.
NACOs could also be used in people at lower risk of stroke than previously thought, doctors note in the new guidelines. Although the evidence supporting this recommendation is not yet definitive, recent research suggests that the potential for stroke prevention may outweigh the potential risks badociated with taking NACOs for longer. of people than what was traditionally advised to take blood thinners.
The guidelines emphasize that two groups of patients with atrial fibrillation should not take NACOs. People with mechanical heart valves should take warfarin, as well as people with mitral stenosis, a narrow valve opening that limits blood flow between the left cavities of the heart.
The new drugs have not been well studied in patients with mitral stenosis and there is some evidence to suggest that they may not work as well as warfarin in patients with mechanical valves, said January.
"The message to remember for patients is that we have oral anticoagulants badociated with a risk reduction similar to warfarin stroke, but a much safer profile with respect to the risk of stroke." "Hemorrhage," said Dr. Wesley O'Neal, a cardiologist at Emory University School of Medicine in Atlanta who was not involved in the recommendations.
"Your doctor can determine your individual risk of stroke and recommend one of these medications if your risk of stroke is considered high enough to benefit from oral anticoagulation," he said. O'Neal by email.
The new guidelines have been published jointly by the American Heart Association, the American College of Cardiology and the Heart Rhythm Society to update the 2014 warfarin recommendations.
In addition to endorsing NACOs, the new guidelines also advocate weight loss in patients with overweight atrial fibrillation. Weight loss can reduce the health risks badociated with atrial fibrillation and can also help reduce high blood pressure.
SOURCE: bit.ly/2CP9sjb Circulation, online 28 January 2019.
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