WEDNESDAY, April 25 (HealthDay News) -- When patients with
atrial fibrillation stop taking anti-clotting drugs, their stroke
risk goes up quickly, new research finds.
That risk increases about the same whether they are taking
warfarin or a newer, more expensive drug, Xarelto
Atrial fibrillation is an abnormal heart rhythm in which the
upper chambers of the heart quiver or flutter instead of
contracting correctly, raising the risk of stroke fivefold.
Patients are often put on anti-clotting drugs to ward off
But some people need to temporarily stop taking anti-clotting
drugs before surgery or other medical procedures to prevent excess
bleeding, while other patients permanently stop taking
anti-clotting drugs because of side effects, researchers said.
Researchers analyzed data from a previous trial including more
than 14,000 patients with atrial fibrillation. In that trial,
rivaroxaban was found to be as effective as warfarin in preventing
stroke and blood clots. Both drugs carried about an equal risk of
causing excessive bleeding.
In the new study, researchers concentrated on patients who had
stopped taking the drugs, either temporarily or permanently.
Regardless of which drug was stopped, the rate of strokes and blood
clots went up about the same.
Decisions to halt either warfarin or rivaroxaban should be made
carefully, since going off the drugs means the heightened stroke
risk associated with atrial fibrillation returns, said lead
researcher Dr. Manesh Patel, an assistant professor of medicine at
Duke University School of Medicine.
"All anticoagulation decisions in patients with atrial fibrillation require risk benefit analysis, and for patients and physicians periods without anticoagulation coverage should be minimized," Patel said.
The study was to be presented Wednesday at the American Heart
Association Emerging Science Series.
Atrial fibrillation affects more than 2.3 million men and women
in the United States and accounts for more than 15 percent of all
strokes, said Dr. Gregg Fonarow, a professor of cardiology at the
University of California, Los Angeles. Anticoagulation therapy
reduces the risk of stroke by 60 to 80 percent in patients with
atrial fibrillation, Fonarow said.
Yet there are key differences between the older and the new
drug, including price and how much monitoring is needed, experts
Patients taking warfarin need to have the levels of the drug
monitored and adjusted regularly to insure it is being effective
and not increasing the risk of serious bleeding, while patients
taking rivaroxaban don't require as careful monitoring.
"While the newer oral anticoagulants rivaroxaban and dabigatran (Pradaxa) cost approximately $250 a month compared with warfarin, which costs only a few dollars a month, these new agents have the advantage of not requiring monthly blood draws and providing more reliable anticoagulation," Fonarow said.
Because this research has not yet been published, it has not
been subjected to the rigorous scrutiny given to research published
in peer-reviewed medical journals and should be viewed as
The study was partly funded by Johnson & Johnson and Bayer
HealthCare AG, which makes rivaroxaban.
American Heart Association has more on atrial
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