Safer drug combination found for patients with high-risk atrial fibrillation

March 05, 2015

Patients with high-risk atrial fibrillation, or AFib, often require one drug to regulate heart rhythm and a second drug to thin their blood and reduce the risk of stroke. A recent study led by a University of Missouri School of Medicine cardiologist found that use of a newer blood thinner significantly decreased the risk of strokes for patients with AFib who require both types of medication.

Although the anticoagulant warfarin has been the standard of care since the 1940s, more recent advancements in blood-thinning medication led to the development of the drug apixaban. The 2011 ARISTOTLE trial, conducted internationally, found that patients with atrial fibrillation taking apixaban had fewer strokes than those taking warfarin.

Greg Flaker, M.D., the Wes and Simone Sorenson Chair in Cardiovascular Research at the MU School of Medicine, directed a team of researchers who recently reviewed data from the ARISTOTLE trial.

Flaker's study indicated that the rate of stroke or blood clot to the body was 39 percent lower in those patients taking the amiodrarone-apixiban drug combination, compared to taking the amiodarone-warfarin combination.

"Although warfarin works very well for most patients who take it, we know that it can be a difficult medication to regulate ? especially when combining it with another drug," Flaker said. "About 30 percent of patients taking warfarin experience fluctuations in blood thickness, depending on how warfarin is metabolized by the individual. Interaction with another drug, such as amiodarone, also affects how warfarin is metabolized."

"Amiodarone is a common and effective drug used to normalize irregular heart rhythm caused by atrial fibrillation," Flaker said. "However, because clotting is a complication associated with the condition, an anticoagulant or blood thinner is frequently used to reduce that possibility. Warfarin has been used as a blood thinner in this capacity for quite some time."

Flaker, a member of the Steering Committee for the earlier ARISTOTLE clinical trial, and his research team reviewed data from that trial in their study.

"Our study mirrored the ARISTOTLE trial in that apixaban proved to be a better blood -thinning medication for all patients with atrial fibrillation," Flaker said. "We looked at the specific drug combination of apixaban and amiodarone. We found that if you had atrial fibrillation and were taking amiodarone to control your heart rhythm, your stroke risk would be higher if you took warfarin than if you took apixaban."

"Certainly there are factors such as cost, physician preference and patient decision-making that affect what drug we use to reduce stroke risks," Flaker said. "The good news for AFib patients is that there is a very good alternative to warfarin for their physicians to consider when developing care strategies for patients with high-risk atrial fibrillation."

The study led by Flaker recently was published in the Journal of the American College of Cardiology, a publication of the American College of Cardiology Foundation. Funding for the study was sponsored by Bristol-Myers Squibb and Pfizer.
-end-


University of Missouri-Columbia

Related Stroke Articles from Brightsurf:

Stroke alarm clock may streamline and accelerate time-sensitive acute stroke care
An interactive, digital alarm clock may speed emergency stroke care, starting at hospital arrival and through each step of the time-sensitive treatment process.

Stroke patients with COVID-19 have increased inflammation, stroke severity and death
Stroke patients who also have COVID-19 showed increased systemic inflammation, a more serious stroke severity and a much higher rate of death, compared to stroke patients who did not have COVID-19, according a retrospective, observational, cross-sectional study of 60 ischemic stroke patients admitted to UAB Hospital between late March and early May 2020.

'Time is vision' after a stroke
University of Rochester researchers studied stroke patients who experienced vision loss and found that the patients retained some visual abilities immediately after the stroke but these abilities diminished gradually and eventually disappeared permanently after approximately six months.

More stroke awareness, better eating habits may help reduce stroke risk for young adult African-Americans
Young African-Americans are experiencing higher rates of stroke because of health conditions such as high blood pressure, diabetes and obesity, yet their perception of their stroke risk is low.

How to help patients recover after a stroke
The existing approach to brain stimulation for rehabilitation after a stroke does not take into account the diversity of lesions and the individual characteristics of patients' brains.

Kids with headache after stroke might be at risk for another stroke
A new study has found a high incidence of headaches in pediatric stroke survivors and identified a possible association between post-stroke headache and stroke recurrence.

High stroke impact in low- and middle-income countries examined at 11th World Stroke Congress
Less wealthy countries struggle to meet greater need with far fewer resources.

Marijuana use might lead to higher risk of stroke, World Stroke Congress to be told
A five-year study of hospital statistics from the United States shows that the incidence of stroke has risen steadily among marijuana users even though the overall rate of stroke remained constant over the same period.

We need to talk about sexuality after stroke
Stroke survivors and their partners are not adequately supported to deal with changes to their relationships, self-identity, gender roles and intimacy following stroke, according to new research from the University of Sydney.

Standardized stroke protocol can ensure ELVO stroke patients are treated within 60 minutes
A new study shows that developing a standardized stroke protocol of having neurointerventional teams meet suspected emergent large vessel occlusion (ELVO) stroke patients upon their arrival at the hospital achieves a median door-to-recanalization time of less than 60 minutes.

Read More: Stroke News and Stroke Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.