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Atrial Fibrillation: New Oral Anticoagulants are safer but expensive

Stroke and bleeding are two complications that may occur when INR levels are not maintained.

Dr. S RamaKrishnan

Additional Professor, Dept. of Cardiology, AIIMS, New Delhi


.We have simplified prevention of heart disease to one simple slogan. Say no to these 6S- salt, sugar, sedentary lifestyle, smoking, stress and saturated fats,” says Dr. Ramakrishnan “Atrial fibrillation is the condition of blood clotting due to chaotic ‘out-of-rhythm’ contraction of the atria. Blood is not pumped forward due to irregular contractions resulting in statis (a slowdown or stoppage in blood flow) and in turn, formation of blood clot. The condition of a stroke or TIA occurs when this blood clot ends up in a brain artery,” he explains atrial fibrillation. Regarding drug therapy for atrial fibrillation, Dr. Ramakrishnan says, “Blood thinners or oral anticoagulants are used to prevent blood from clotting. But the problem with anticoagulation is that, they have a narrow therapeutic range. In the effect range (optimum dose), they prevent stroke but in the complication range (excess dose), they cause bleeding. This narrow window between blood clot prevention and bleeding is maintained by regular INR (International Normalized Ratio) monitoring.” “It is the lack of compliance and irregular INR monitoring that causes complications most times. But even after having maintained INR levels, many patients develop strokes or present with bleeding complications due to erroneous INR readings,” he elucidates problems encountered in anticoagulation. “The new oral anticoagulants have shown higher efficacy and greater safety but their high costs are prohibitive

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Dr.Kunal Jhaveri

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.


Dr. Ramakrishnan

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


Dr.Kunal Jhaveri

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


Dr. Ramakrishnan

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


Dr.Kunal Jhaveri

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


Dr. Ramakrishnan

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.


Dr.Kunal Jhaveri

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



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  • MI
  • ECG
  • Hypertension
  • BypassSurgery
  • Stent

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