Atrial Fibrillation Treatment Receives New Guidelines & Blood Thinner

Craig T. January, MD, PhD

Updates to the atrial fibrillation guidelines now recommend a newer type of blood-thinning medication called non-vitamin K oral anticoagulants (NOACs) as the preferred alternative to warfarin for reducing the risk of stroke associated with atrial fibrillation (AFib).

The new recommendation comes as a part of the “2014 American Heart Association/American College of Cardiology/Heart Rhythm Society Guideline for the Management of Patients With Atrial Fibrillation.” In addition to the new blood thinner, the guidelines also recommend overweight or obese people with AFib to lose weight.

“These are important changes,” Craig T. January, MD, PhD, co-chair of the focused update published simultaneously in the American Heart Association journal Circulation, Journal of the American College of Cardiology and the Heart Rhythm Society journal, HeartRhythm, told MD Magazine®.

“One is that we define better ‘nonvalvular atrial fibrillation,’ as this term has been confusing to many health care providers. Another is the recommendation of NOACs in preference to warfarin (except for patients with moderate to severe mitral stenosis or an artificial (mechanical) heart valve). NOACs compared to warfarin continue to show evidence of less bleeding risk and for some possible reduced stroke risk. There are also several other changes that broaden recommended uses of NOACs and address specific disease states.”

Since AFib causes irregular heartbeats that can cause blood to pool and then clot inside the atria, blood-thinning medications called anticoagulants are often prescribed to reduce the risk of stroke. While warfarin has long stood as the preferred medication, NOACs are now the preferred choice of medication. NOACs include dabigatran, rivaroxaban, apixaban, and edoxaban.

Based on the quality and quantity of the scientific research that supports each recommendation, guidelines rank recommendations as strong, weak, or harmful. Unlike the lowest-ranked recommendation, which are based on the clinical experience of experts, the highest-ranked recommendation has more than 1 randomized controlled trial reporting similar results.

In addition to the guidelines recommending NOACs over warfarin for many patients, they also recommend obese patients lose weight due to previous studies that have found the health risks associated with AFib can decrease or reverse with weight loss.

Additionally, reversal agents that can reverse the effects of NOACs are available. Although they are used infrequently, they can be helpful when there are signs of severe bleeding caused by a NOAC or when a patient on a NOAC needs an emergency surgical procedure.

NOACs can also be used in individuals with a lower risk of stroke than previously thought. While evidence for this indication is not yet definitive, the benefit of NOACs for reducing stroke risk outweighs the risk of taking them, according to newly emerging research.

“AFib patients should talk to their healthcare provider about any concerns they have about their prescribed medications and whether or not losing weight would benefit their health,” said January, who is professor of cardiovascular medicine at the University of Wisconsin in Madison, Wisconsin, said in a recent statement.