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Atrial Fibrillation: NOACs, Warfarin and Vitamin K Antagonist

Controlling risk factors like Hypertension, Diabetes, Dyslipidemia and obesity helps prevent Atrial Fibrillation

Dr. Mohan Nair

HOD - Cardiology

Holy Family Hospital, Delhi


A recent study corrected the misconception of rheumatic fever fading away by stating that 50% of Atrial Fibrillation in India is still rheumatic. Prevalence of both valvular and nonvalvular atrial fibrillation in India is equal. “At least 30% of the so called idiopathic or cryptogenic CVA or TIA turn out to be atrial fibrillation,” says Dr. Mohan Nair about under-detection of the disease. “Treating hypertension, dyslipidemia and other coronary risk factors like diabetes is the key to curbing Atrial Fibrillation,” says Dr. Mohan Nair on the importance of risk factor reduction. “The risk of bleeding deters physicians from the use of anticoagulants like Warfarin. Also, the reaction of many Indian foods and medicines with Warfarin is unknown. This is where the New Oral Anticoagulants have taken over in terms of safety,”

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Dr.Kunal Jhaveri

</b>Today we have one of the leading interventional cardiologist doctor and professor Mohan Nair who is currently the coordinator and head of the Department of Cardiology from Holy Family Hospital based at Delhi. Sir, it is warm welcome for revolution talk. Sir, as you know regarding the arrhythmic disorder the atrial fibrillation we can say it is a commonest arrhythmic disorder wherein the incident rate is of around 30 to 33%. But still there is a debate on whether this incidence rate globally which is around 1.8 to 2%, whether it is a actual one or it may be a fact number, so what is your take on this particular aspect.


Dr. Mohan Nair

</b>See actually, we did look at this and coming and also because of atrial fibrillation treatment was getting changed when I was of President of Indian Heart Rhythm Society about two years back, we did very reasonably large (01


Dr.Kunal Jhaveri

</b>So definitely it is very well said that in India because the rheumatic condition is so widely prevalent, number of the valvular AF cases are much more as compared to the non-valvular cases.


Dr. Mohan Nair

</b>It is equal now, it is almost equal.


Dr.Kunal Jhaveri

</b>Now it is getting more equal. There is also one concept regarding the screening of atrial fibrillation going on, that how we can, means, that a clear and on time diagnosis of atrial fibrillation and we go ahead. So which kind of risk factors, if the patient is having these kind of risk factors, then you will focus more that this patient should have screening for the atrial fibrillation.


Dr. Mohan Nair

</b>See a lot of patients (03


Dr.Kunal Jhaveri

</b>Yes, perfect there. Regarding for the control of atrial fibrillation the surgical intervention is also now happening and the rate and rhythm control, some ablation kind of procedures are also now very prevalent (05


Dr. Mohan Nair

</b>See as far as I do of course get filtered patients on what I say my practice may not reflect the general practice but that will reflect over a period of time. As far as evidence goes, it is very clear that unless you have a CHADS2 score of 0 or 1, aspirin has no role, nor does aspirin from clopidogrel, that is last choice, only if no anticoagulation can be used. Two and above you have to have rigorous anticoagulation (06


Dr.Kunal Jhaveri

</b>Definitely, this is a very practical point that you have raised that vitamin K antagonists have this type of limitation and new oral anticoagulants can resolve all these limitations regarding the INR monitoring and better compliance. Now this is last question. Regarding the new oral anticoagulants, as of now three new oral anticoagulants are available in India, factor X inhibitors and direct thrombin inhibitor. So in your experience how you have found that this drug should be given for such kind of patients. How you choose the new oral anticoagulants for treating this.


Dr. Mohan Nair

</b>See honestly the first staff meeting with the new oral anticoagulants was in Brussels in Belgium and I was there from that time onwards. So in India, honestly dabigatran has the first more advantage. So this was the International swab, (09


Dr.Kunal Jhaveri

</b>Definitely, it is a very practical thing that you have mentioned regarding this, as of now there is no clear cut comparison between.


Dr. Mohan Nair

</b>There will not be. I do not think there will be.


Dr.Kunal Jhaveri

</b>Definitely or even in far


Dr. Mohan Nair

</b>We have event of registries and post marketing service but otherwise you do not have a


Dr.Kunal Jhaveri

So that is what, one new oral anticoagulant will not be fit for all kinds of patient, you have to be customize and based on the patient’s requirement and risk factor and conditions you have to choose that.


Dr. Mohan Nair

</b>Absolutely.


Dr.Kunal Jhaveri

</b>So with this note, we are ending our discussion. Thanks a lot doctor for providing us your valuable thoughts.


Dr. Mohan Nair

</b>Thanks.



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