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Non-valvular Atrial Fibrillation rare in India

Due to lack of adherence to regular INR monitoring, most doctors end up giving suboptimal doses of anticoagulants, which may not be effective in stroke prevention
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Dr. B Keshava Murthy

Senior Interventional Cardiologist

Meenakshi Hospital, Thanjavur


Dr. B Keshava Murthy from Meenakshi Hospital, Thanjavur performs on Due to lack of adherence to regular INR monitoring, most doctors end up giving suboptimal doses of anticoagulants, which may not be effective in stroke prevention

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Dr.Kunal Jhaveri

</b> So sir today what we are going to discuss basically on there is one of the commonest arrhythmic disorder is atrial fibrillation and some part of the thromboembolic disorders also as well and what is the role of newer generation oral anticoagulants in particular these two kinds of the diseases. So sir as you know that atrial fibrillation is one of the commonest arrhythmic disorder but still the global prevalence rate if you see it is around 1.8 to 2%, in India I do not think as of now we have any established history that we can establish particular kind of the incidence rate of atrial fibrillation, so in your practice as a cardiologist, what you have found that the patient's incidence rate and the diagnosis of this particular disease, is it very regularly and frequently coming on time or not and if it is not happening, then what could be the possibilities.


Dr. Murthy

</b>In terms of non-valvular atrial fibrillation, in India may be lesser than foreign countries because Western population live longer, they do not have rheumatic heart disease. We have more of (01


Dr.Kunal Jhaveri

</b> Okay, so it is low and also the detection of atrial fibrillation is also not happening on the particular time like the paroxysmal atrial fibrillation.


Dr. Murthy

</b>Atrial fibrillation detection is definitely we have diagnosing them early and treating them, but non-valvular atrial fibrillation per se incidence is low in India.


Dr.Kunal Jhaveri

</b> Okay, so if we talk about the risks and complications of the particular atrial fibrillation for one of the commonest thromboembolic disorder is stroke, it is associated with non-valvular atrial fibrillation as well (02


Dr. Murthy

</b>Really, we put atrial fibrillation patient who are elderly atrial fibrillation patients, based on CHADS score we put them on oral anticoagulants, especially elderly woman who have got diabetics we tend to put them on anticoagulants in addition to aspirin or without aspirin, we tend to put them on oral anticoagulants but the issue is they will not be any regular followup for measuring the anticoagulant value like PT/INR, (03


Dr.Kunal Jhaveri

</b> So definitely what you have said rightly that the practical challenge is a regular followup of the patient, especially the INR monitoring and PT monitoring is not possible even in the internal part of the India as well and that may the biggest challenge for this particular group of the drugs. So to answer them, the newer generation of oral anticoagulants are available like rivaroxaban, apixaban and dabigatran, so sir what is your experience on this particular group of the disease in various condition you must have used SPAF, deep venous thrombosis, thromboembolic disorder, so what is your experience of this group of molecules.


Dr. Murthy

</b>I should agree (04


Dr.Kunal Jhaveri

</b> Okay, so what about the stroke prevention atrial fibrillation, these all three drugs are also indicated in this group of the disease.


Dr. Murthy

</b>Let me be frank that I have not seen a (05


Dr.Kunal Jhaveri

</b> Definitely, that is fine, now the thing is that you talk about atrial fibrillation, its detection is also very, very difficult, the screening part is also very less, so if you want specific important takeaway from your side for the patients even for the physicians and who have the DM cardiologist (06


Dr. Murthy

</b>It is a very difficult question to answer because if CHADS score says that the patient is high risk of stroke or atrial fibrillation like the patient has got coexisting disease like diabetes, obese in little girls and woman then we should put them on oral anticoagulants. One of the choices would be newer anticoagulant which does not require an anticoagulant monitoring. Having said that whether they will comply with the higher cost of this drug is one issue in area which requires what you say experience (07


Dr.Kunal Jhaveri

</b> Regarding the CHADS score, definitely you can assess the patient those who are high risk for the stroke, now would you like to advise at physician level that though when the patient are coming with such kind of high risk conditions, like the age, myocardial infarction, and congestive heart failure, then you should go for some kind of screening procedures like ECG and pulse palpation method so that they can have some idea regarding this particular arrhythmic disorder and the treatment can be started as soon as possible.


Dr. Murthy

</b>As such, most of the patients who attend to me or attend the physician, definitely India is a grown up country, it is a developed country actually for because I feel we in a small town like, we have crossed 1000 angioplasties in last three years, so (08


Dr.Kunal Jhaveri

</b> So I think sir it a very fair discussion what we have and as the sir has suggested very frankly that atrial fibrillation is definitely it is a common arrhythmic disorder and India is one of the growing country, (09



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