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Anticoagulants recommended for people with irregular heartbeat

Tuesday February 25, 2014
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An updated guideline from the American Academy of Neurology recommends that people with nonvalvular atrial fibrillation, or irregular heartbeat, take oral anticoagulants to prevent stroke.

Taking anticoagulants especially is important for people who already have had a stroke or transient ischemic attack, according to the guideline, which was published in the Feb. 25 issue of the journal Neurology and was endorsed by the World Stroke Organization.

Irregular heartbeat is a major risk factor for stroke. “The World Health Organization has determined that atrial fibrillation is nearing epidemic proportions, affecting 0.5% of the population worldwide,” Antonio Culebras, MD, of SUNY Upstate Medical University in Syracuse, N.Y., the lead author of the guidelines and a Fellow of the American Academy of Neurology, said in a news release.

The uneven heart rhythm allows blood to remain in the heart’s upper chambers. The blood can then form clots, which may escape the heart and travel to the brain, causing a stroke. About one in 20 people with untreated atrial fibrillation likely will have a stroke in the next year, according to the news release. Anticoagulants are highly effective in preventing stroke, but they also carry a risk of bleeding and should be used only under close medical supervision.

Several new anticoagulant pills have been developed since the AAN’s last guideline on this topic, which was published in 1998. The current guideline determined that the new anticoagulant pills, such as dabigatran, rivaroxaban and apixaban, are at least as effective as the established treatment of warfarin and have a lower risk of bleeding in the brain. In addition, the new drugs have the added convenience of not requiring blood testing as frequently as warfarin.

The guideline also extends the value of this type of blood thinner to many people who generally are undertreated — such as the elderly, those with mild dementia and those at moderate risk of falls — and whose health status was long thought to be a barrier to use.

“Of course, doctors will need to consider the individual patient’s situation in making a decision whether or not to use anticoagulants, and which one to use, as the risks and benefits can vary for each person,” Culebras said.

Culebras also noted that the guideline addresses special circumstances that may pertain to developing countries where new anticoagulant pills are not available or not affordable.

Neurology is the medical journal of the American Academy of Neurology. Guideline: www.neurology.org/content/82/8/716.full


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