The American Heart Association reports that more than two million Americans have atrial fibrillation, a rhythmic disorder of the heart where the atria (the heart’s pumping chambers) quiver instead of beat. Because of the risk of stroke and systemic embolism associated with atrial fibrillation, patients are often prescribed anticoagulation medication to prevent these secondary adverse outcomes. The most common medication is warfarin, also known as Coumadin® or Jantoven®.
Three new medications approved for afib patients
However, three new anticoagulants have recently been approved by the Food and Drug Administration: dabigatran (Pradaxa®), rivaroxaban (Xarelto®) and apixaban (Eliquis®). This means that warfarin, Jantoven® and Coumadin® alternatives are now available for patients diagnosed with atrial fibrillation who need an anticoagulant. While these new medications do not require routine lab monitoring as warfarin does, patients may pay higher medication copays, depending on insurance coverage, says Brian Kurtz, clinical pharmacist, University of Michigan Cardiovascular Medicine.
How do the new drugs compare with warfarin?
Like warfarin, dabigatran, rivaroxaban and apixaban are oral medications. “Unlike warfarin, they require no routine efficacy or dosage monitoring, which makes them attractive options in the prevention of stroke and systemic embolism,” says Kurtz. These newer agents also begin affecting anticoagulation in hours versus several days with warfarin therapy.
Kurtz warns, however, that the new oral anticoagulants also have limitations, including drug interactions and the lack of a reversal agent to counteract them in case of major bleeding. And, because the products are branded, the direct cost is higher than warfarin therapy.
While these medications provide doctors with more options for atrial fibrillation patients in the prevention of stroke and systemic embolism, Kurtz advises interested patients to speak with their healthcare professional to find out if one of these medications is a possible option for them. To make an appointment with a University of Michigan heart doctor to discuss your heart arrhythmia, contact the University of Michigan Frankel Cardiovascular Center call line toll-free at 888-287-1082.
The University of Michigan Samuel and Jean Frankel Cardiovascular Center is the top-ranked heart and heart surgery program among Michigan hospitals. To learn more, visit the Heart and Vascular page on UofMHealth.org.