-- Randy Dotinga
THURSDAY, Feb. 2 (HealthDay News) -- A new medication that helps
prevent strokes in people with the abnormal heart rhythm disorder
known as atrial fibrillation poses less risk of bleeding in the
brain than a commonly used drug, research comparing rivaroxaban
(Xarelto) and warfarin suggests.
Anti-clotting medications, also called blood-thinners or
anticoagulants, include warfarin (Coumadin) and aspirin, among
others. In patients with atrial fibrillation, these drugs can
reduce the risk of ischemic stroke, which occurs when a vessel
becomes clogged by a blood clot. But the drugs can also cause
excessive bleeding because they make it harder for blood to
In a new study, researchers led by Dr. Graeme Hankey, a
neurologist at the Royal Perth Hospital and University of Western
Australia, followed more than 14,000 people who took anti-clotting
drugs for a median of two years. Of those patients, 136 had
bleeding in the brain.
People who took a new anticoagulant called rivaroxaban (Xarelto)
-- and suffered from the most common type of atrial fibrillation
and didn't have heart valve damage -- were about one-third less
likely to experience bleeding in the brain than those who took
warfarin, the investigators found.
So which drug is best?
In the big picture, "all of the newer [blood-thinning] drugs are
reported to have lower intracranial bleeding risks than Coumadin
[warfarin] when used in the setting of atrial fibrillation to
prevent stroke," said Dr. Ken Uchino, program director of the
Vascular Neurology Fellowship at the Cleveland Clinic's
Cerebrovascular Center, who was not involved with the study but is
familiar with the findings.
"This is one advantage, but in absolute terms it is small -- on average going from 0.7 percent per year of intracranial bleeding risks to 0.5 percent per year for rivaroxaban -- though this is a 33 percent decrease for rivaroxaban," Uchino explained.
The new drugs are more convenient than warfarin, which requires
the administration of blood tests to make sure patients are getting
the proper doses. But "there have been concerns about unanticipated
risks and how the new medications are all short-acting -- what
happens if one misses doses? -- and cleared by the kidneys -- what
happens if the kidneys start to fail without anyone knowing?"
Also, the newer anti-clotting drugs are expensive.
The study, which was funded by Johnson & Johnson and Bayer
HealthCare, was slated for presentation Thursday at the American
Stroke Association's International Stroke Conference, in New
Because this study was presented at a medical meeting, the data
and conclusions should be viewed as preliminary until published in
a peer-reviewed journal.
The U.S. National Institute of Neurological Disorders and Stroke
has more about
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