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Pharmacy Prof Says Some Patients with A-Fib Should Be Prescribed a New Drug
Atrial Fibrillation, commonly referred to as "a-fib,” has become recognized as a cardiac health concern that in many cases can lead to stroke and death. There are currently nearly 3 million cases in the United States—and, by 2050, it is projected that more than 7.5 million people will have a-fib.
With so many Americans living with this condition, Dr. Sarah Spinler, a clinical pharmacy professor at University of the Sciences, believes that some patients with a-fib should be prescribed a new oral anticoagulant drug instead of warfarin—a blood thinner also known by its brand name Coumadin.
Earlier this year, the U.S. Food and Drug Administration approved edoxaban, a new oral anticoagulant manufactured by Daiichi Sankyo. The drug is marketed under the brand name Savaysa and joins three other new drugs in the new oral anticoagulant marketplace: dabigatran (Pradaxa) from Boehringer Ingelheim, rivaroxaban (Xarelto) from Johnson & Johnson, and apixaban (Eliquis) from Pfizer and Bristol-Myers Squibb.
All four drugs were designed to overcome the limitations of warfarin, which has long been available as an inexpensive generic drug but which requires extensive monitoring and dose adjustment and has numerous interactions with other drugs and foods.
As the mainstay a-fib treatment, Dr. Spinler said warfarin has proven to be a highly effective therapy, but it does have several limitations, including dietary effects, drug-drug interactions, and a need for regular international normalized ratio monitoring.
“Patients with well-managed warfarin treatment may not see a big benefit when switching to a new oral anticoagulant drug,” said Dr. Spinler. “However, patients with nonvalvular atrial fibrillation who are unable to maintain a therapeutic international normalized ratio level with warfarin should be prescribed a drug such as dabigatran, apixaban, and rivaroxaban.”
Reduced doses of new oral anticoagulant drugs may also be appropriate for patients with nonvalvular a-fib and moderate to severe chronic kidney disease with CHA2DS2-VASc scores of 2 or greater (this score calculates stroke risk for patients with a-fib). These new drugs also tend to require fewer dosing changes, Dr. Spinler added.
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