New Anticoagulants to take over in the future

High costs and non-availability of antidotes are the only barriers
Dr. SK Parashar

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Dr.Kunal Jhaveri

Today, we have one of the leading consultant cardiologist, Dr. SK Parashar. He is currently from the Metro Group of Hospitals of Delhi. He is one of the past president of the cardiologist society of India. Sir, it is a warm welcome for this particular television talk show. Sir, as we know that regarding the disease of atrial fibrillation, it is one of the common arrhythmic disorder and if it is not going to control very well then there is major chance of risk of stroke development at a later time. It is almost five times higher than the non atrial fibrillation condition. Sir you have one of the wide experience in cardiological therapeutic area and you have gone through various kinds of stroke management patients with atrial fibrillation from the oral anticoagulants, older one then the antiplatelets and now the newer generation. So, step by step you have seen the improvement and also the advantages and disadvantages of this group of molecule (01:00). So what is your final take on on this particular group of the molecules that it can improve the preventing stroke condition.

Dr. SK Parashar

Yeah, you rightly said that it is one of the commonest arrhythmias and its incidence goes on increasing with increasing age and besides other things you have rightly pointed out that stroke is one of the biggest threat of almost four to five times as compared to normal individual or so. So our aim has been to control the stoke. Previously we had the vitamin K antagonists or so, of course it had some advantage, disadvantage, you had an get an INR done every time and then again you have to see the various readings out of things or so, then in the last few years some newer drugs have come out, like rivaroxaban, dabigatran and one or two more or so. Newer anticoagulants (02:00) have made sort of a very major breakthrough. Now you cannot say which is good, which is bad, which is all these. There are two things, I will say the problem with the new anticoagulants is their cost. In a country like India, say if the medicine is very costly, it produces less compliance on the part of the patient because it has to go throughout the life of the patient and if it is very costly then of course it creates a problem. However, they are very effective. It is sort of a double-edged weapon and although anti-dote to these drugs are being developed, but I think they are not freely available in India, that is one problem and the vitamin K anticoagulant, they of course it is very commonly available. (03:00). So various head-to-head comparisons have been done and they got advantages and disadvantages, for example dapigatran they get more of gastrointestinal bleeding, less of an intracranial bleeds or so. It has to be given twice a day. Other drugs are given once a day and gastric irritation is less in these situations. So there are definitely a lot of head-to-head trials are being done and should be done to see as to which one is good but I would say that these newer ones, they have created a really good revolution in the prevention of atrial fibrillation. Because we have to find out the seriousness, how much a person is prone to is by the same CHA2DS2-VASc score is very important, we grade the patient and the higher the score, the poorer is the outlook (04:00), so we have to be very cautious in these patients. The only thing we have to see is besides cost we have to see if they have any history of any chronic dyspepsia, any renal impairment or so. So I would say, my personal take is that these drugs will gradually take over the older drugs or so, provided the cost factor is considered and very rapidly available antidote is available. So they will definitely take over. We have used the dabigatran and other drugs also and let us see how this goes on.

Dr.Kunal Jhaveri

Definitely, so this is very well said and it is very brief. There is entire information regarding the newer generation oral anticoagulants. They have advantages against the older one regarding INR monitoring and better efficacy even safety as well. Safety is the major video of this particular new oral anticoagulants as compared with the vitamin K (05:00) antagonists but provided the cost is a factor which can lead to the longer time of adherence with this particular kind of treatment. So this is a challenging factor and along with that also an antidote should be freely available and it should be available because the dabigatran antidote is already approved in US FDA. Rest of the rivaroxaban, apixaban antidote is going on. So very soon it should be there in India but it is a matter of future but as of now, it is not available in India.

Dr. SK Parashar

That is one of the limiting factors which is coming because we do not know what to do in these situation.

Dr.Kunal Jhaveri

Yeah, what to do with these kind of drugs. So it is very short and it is a very practical approach regarding the new oral anticoagulants and stroke prevention atrial fibrillation. So, I think with this note we are ending our discussion. Thanks a lot Dr. Parashar for your all valuable comments.

Dr. SK Parashar

Thanks very much and I can assure you that these drugs are going to take over in future.