Abstract
Introduction of the new oral anticoagulants (NoACs) to prevent and treat thromboembolic phenomena is one of the most significant innovations in clinical practice in the past 50 years. It has been about 6 years since the first new oral anticoagulant gained approval for stroke prevention in atrial fibrillation (AF) in the United States. The new anti-coagulants (Factor Xa inhibitors and factor IIa inhibitors) have major pharmacologic advantages over vitamin K antagonists (inhibiting clotting factors II, VII, IX, and X) and a very few disadvantages. Warfarin is still the drug of choice for patients with mechanical heart valves. If the patients’ compliance is debatable NoACs will not be the drugs of choice as the off-set toxicity is high to create new clots. Cost of the NoACs is higher than warfarin but somewhat similar to low molecular weight heparin (which is administered subcutaneously). With increasing familiarity among the practitioners NoACs will establish a bigger market, and long term effects of using these drugs will be known. In this article we have compared warfarin with the commonly used new oral anticoagulants to determine whether their use is safe in Sri Lanka.
Highlights
atrial fibrillation (AF) is the most common sustained cardiac arrhythmia and is associated with an increased risk of stroke and other thromboembolic events.[1]
In 1948 the research carried out at the University of Wisconsin discovered warfarin and it gained the name WARF (Wisconsin Alumni Research Foundation) and “arin” because it is derived from coumarin.[4,5]
The trials helped to compare the risks, benefits, long term effects and the cost to evaluate the long term effectiveness of these drugs compared to warfarin on patients with non valvular AF
Summary
AF is the most common sustained cardiac arrhythmia and is associated with an increased risk of stroke and other thromboembolic events.[1]. Bleeding can occur anywhere and most catastrophic is into the brain and spinal cord.[9] Rare but a serious complication associated with warfarin therapy is necrosis This is seen in patients with protein C (innate anticoagulant) deficiency. The most commonly used drugs are Rivaroxaban, Dabigatran and Apixaban Rivaroxaban This was the first available oral factor Xa inhibitor that came to the market. After hip replacement - 10mg a day for 35 days Dabigatran This is a direct thrombin inhibitor that is used to reduce the risk for stroke and systemic embolism in patients with non valvular AF and to prevent and treat venous thromboembolism.[14].
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