A landmark study published in the New England Journal of Medicine suggests that patients with atrial fibrillation (AF), a common and potentially life-threatening heart condition, can benefit from a new drug that can better manage the disorder: rivaroxaban. The international study was conducted by researchers at Duke University and the University of Edinburgh and involved 14,264 patients with AF worldwide. This well-designed study found that rivaroxaban was as effective as warfarin at preventing stroke or blood clots but came with fewer side effects related to bleeding.
AF is the most common irregular heartbeat disorder, affecting about 250,000 Canadians. A normal heart pumps blood regularly throughout the body through coordinated contractions. However, in patients with AF, the contraction occurs chaotically and rapidly in the atria or the upper chambers of the heart. This can lead to blood being pooled in the heart, forming clots that can later travel to other parts of the body. When this phenomenon occurs in the brain, it often leads to a stroke. The risk of a stroke is four to six times higher in patients with AF. The disorder can affect adults of any age; however, the risk is far higher past the age of 40. By age 60, one third of all strokes are caused by AF.
Warfarin has been the standard treatment for patients with AF for decades. It is an anticoagulant that can treat the condition, but it also leads to an elevated risk of bleeding and requires more frequent monitoring through blood testing and dose adjustments. In addition, it frequently interacts with other medication and can be affected by diet. In fact, one third of all patients who are eligible for warfarin treatments do not take it because they are unable to cope with the frequent monitoring and controlled diet. It is hoped that the results of this new study can offer an alternative treatment for these patients.
Rivaroxaban can provide a more consistent dose of anticoagulant. Patients with prescriptions can take a daily oral dose without having to worry about the complicated and rigorous management associated with warfarin. The results of the study show that bleeding within the skull or bleeding leading to death in patients taking rivaroxaban was less than in those taking warfarin. Patients on this new drug did, however, have higher rates of transfusions and hemoglobin/hematocrit drop versus patients on warfarin. News of the drug’s effects is particularly timely given that AF predominantly affects the elderly and that this age group is expected to increase substantially over the next decades in developed countries.
All things considered, rivaroxaban represents a promising alternative to the standard treatment. While the hope is that it will improve the quality of life for patients with AF, there need to be more studies to validate its safety and efficacy.
