Best Blood Thinner?

iStock_84561969_XXXLARGEAtrial fibrillation is a condition where the upper chambers of our four-chambered heart don't beat together with other heart areas, and this can allow blood clots to form and travel to the brain, causing a stroke.  Now, as Rick and I discuss on PodMed this week, so-called 'novel anticoagulants' have been shown to be as safe and effective at managing this condition as the tried and true warfarin, a study in the BMJ concludes.

The study is compelling because it followed almost 62,000 Danish citizens who were new to using oral medications to thin their blood.  The stalwart warfarin and three upstart novel anticoagulants or NOACs, as those in the know abbreviate, were all used among this cohort.  The NOACs were dabigatran, rivaroxaban and apixaban. Data was collected between August 2011 to October 2015. Briefly, the NOACs were just as good at preventing stroke and in some cases better at avoiding blood clots.  As Rick opines in the podcast, this information should be weighed along with other aspects of treatment with NOACs to assist patients in making an informed decision.  On the plus side, there's no need to monitor to what degree blood is being thinned as there is with warfarin, requiring a regular trip to the clinic some patients find very onerous. On the other hand, there's the ability to reverse warfarin effects readily if surgery is needed.  Then there's the cost issue.  What's not at issue is the importance of employing some strategy to reduce risk in people with atrial fibrillation, so it's good to be able to make informed choices.

Other topics this week include sudden cardiac death among youth in NEJM, and two in JAMA: plant phytoestrogens for menopausal symptoms and dietary consumption trends among US adults.  Until next week, y'all live well.

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