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Media, News & Topics on prevention, diagnosis & treatment of cardiovascular disease
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Xarelto (rivaroxaban) approved for stroke prevention in atrial fibrillation 2 years ago

Xarelto (rivaroxaban) approved for stroke prevention in atrial fibrillation 2 years ago | Heart and Vascular Health | Scoop.it

#OnThisDay (11/4/2011) two years ago the first Factor Xa inhibitor and second novel oral anticoagulant (NOAC) was approved to prevent stroke in atrial fibrillation.  We now have three NOACs available.

Seth Bilazarian, MD's insight:

There are now three NOACs available as an alternative to warfarin (coumadin) and one on the horizon in 2014.   The uptake in the US has been slow.  Xarelto is the only one of the NOACs that has been approved for other indications such as DVT's (clots in the leg), PE (clots in the lung), or the prevention of these problems after knee and hip surgery. Physician and patient familairity and comfort with these new options is slowly growing.

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Eliquis: New Medication for Atrial Fibrillation

An in-depth conversation between Pentucket Medical cardiologists Seth Bilazarian and Sunny Srivastava, focusing on a newly released medicine to reduce the risks of atrial fibrillation. The latest among recently approved blood thinners, Eliquis joins Pradaxa and Xarelto as an alternative to Coumadin, a drug that has been in use since the 1950s. Like Pradaxa and Xarelto, Eliquis has been shown to reduce risk of stroke and bleeding, as well as mortality. All the new drugs eliminate the need for regular blood testing that Coumadin necessitates.

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Anticoagulation in AF: Fork in the road or four-way-stop?

Anticoagulation in AF: Fork in the road or four-way-stop? | Heart and Vascular Health | Scoop.it

The FDA's recent decisions on novel anticoagulants in atrial fibrillation have stirred debate and generated some consternation. For the clinical practitioner, how can we efficiently and effectively communicate the issues related to anticoagulation choice to the patient?  Dr Bilazarian proposes -CRABI:

C - Prescription coverage?
R - Normal renal function?
A - Early adopter?
B - GI bleeding?
I - Instability on warfarin?

Download the powerpoint presentation and the comparative Excel sheet.

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What to do about bridging with novel oral anticoagulants

What to do about bridging with novel oral anticoagulants | Heart and Vascular Health | Scoop.it

Sharing a rare moment of person-to-person time during the scientific sessions in San Francisco, Dr Seth Bilazarian asks Dr. Samuel Goldhaber how he goes about bridging with "Novel oral anticoagulants" (NOACs) #dabigatran, #rivaroxaban, and #apixaban.

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Caution on initial bleeding risk with warfarin

Caution on initial bleeding risk with warfarin | Heart and Vascular Health | Scoop.it

My comment: We have new options for patients with atrial fibrillation.  These new drugs Pradaxa and Xarelto are under scrutiny because they are new nadn bleeding hazard has been reprted.  This study helps us understand that warfarin (coumadin) also has significcant risk and the risk is high in the first week of starting thsi medicine.  This early hazard but be an advatage for the newer options.

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Rates of serious bleeding among patients taking warfarin are much higher than those found in clinical trials of the drug and are even greater during the first month of use, according to a five-year study of 125,195 seniors with atrial fibrillation.

The findings complicate an already difficult decision-making process for patients with atrial fibrillation (AF) and highlight the importance of careful management of warfarin, especially during the first month of use, experts said. Warfarin is a generic anticoagulant that is marketed under brand names such as Coumadin and Jantoven.

Compared with clinical trials for warfarin that found serious hemorrhaging rates of between 1% and 3% per year, bleeding problems are more common in real-life clinical practice, said the study, published Nov. 26 in the Canadian Medical Assn. Journal. In the study, the overall rate of hemorrhaging — bleeds serious enough to send patients to the hospital — was 3.8% per person, per year.

However, during the first month of treatment, the annualized hemorrhage rates were 11.8% in all patients and 16.7% among patients with higher risk of stroke. 

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New Blood Thinner: Xarelto for Atrial Fibrillation (AF) and Stroke Prevention

Xarelto (Rivaroxaban) is a new alternative for prevention of stroke for patients with atrial fibrillation. With its introduction, we now have the oldest option for patients, Coumadin (Warfarin) and another new anticoagulant treatment Pradaxa (Dabigatran) as options available to reuduce stroke (CVA) risk.  Drs Srivistava and Bilazarian discuss the newest entrant and review the data for patients on the series Matters of the Heart produced by Haverhill Community Television and Pentucket Cardiology.

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