Additional Professor, Dept. of Cardiology, AIIMS, New Delhi
Today we have one of the renowned cardiologist from the institute of All India Institute of Medical Science, Dr. Ramakrishnan who is currently associated as an additional professor of Cardiology at AIMS. Sir, it is a warm welcome for this particular revolutionary talk show. As we know that in the cardiovascular segment, now the concept of prevention of disease is now very well doing that everyone is trying that before happening of a disease it should be prevented. So, that chances of morbidity and mortality is very very less. So, from your experience so far, how you will implement this kind of concept in your practice as well.
We all have been saying that prevention is better than cure and always like genius always will prevent the disease and so on and so forth, but when we come to implementation, it is becoming extremely difficult. So exactly what should be done, what exactly should be done, all those things are not very clear in Indian context. So, some of the efforts of cardiologist of the India has been to simplify that (01
So, definitely as you shared regarding the major factors like dietary factor and lifestyle factors, if we can modify then prevention of the cardiovascular disease can be better as of our current condition. One condition also is there regarding the arrhythmic disorder of atrial fibrillation where its complication of stroke. It is prevention is also very much required (02
I think clearly atrial fibrillation is a disease where atria is chaotically contracting. It is not contracting in a uniform pattern, and there is a kind of recess which is kind of an appendage structure that is not useful as such to heart function, that is called the left atrial appendage. There is stasis. Because since the atria is not contracting, there could be formation of clots inside that. Clots always happen when there is stasis and the blood is not pumped forward there is stasis, immediately clot forms (03
Okay, so I think that a very well point is covered that practically with the vitamin K antagonist and how the NOACs can be a better option against the vitamin K antagonist. Sir, if a choice is given to you that you have to select one of the NOACs, as of now three NOACs are available, rivaroxaban dabigatran and Apixaban (06
As of now, it is very difficult to say which one is better and which one is not better. I think it would be, as of now, there is no recommendation, I think all the three are good if you go with the guidelines and criteria and the trials that have been done. Across the trial, if you try to compare, it is a difficult comparison and it is often meaningless if you compare across the trial. The populations are different, the risk groups are different, so as of now I would say that it would be a difficult choice and may be once a day therapy, this could be a rivaroxaban could be some advantage where compliance becomes slightly better. So apart from that, I would not say that one is superior to the other.
Surely, okay, so I think it is very in detail discussion regarding the stroke prevention in atrial fibrillation. So what are the current challenges with older anticoagulants and now what are the advantage of the newer oral anticoagulants(07