Condition

Atrial fibrillation — also referred to as AFib or AF— is the most common abnormal heart rhythm, affecting 350,000 Canadians. It can lead to serious complications, such as stroke and other blood clots.

Drugs

Anticoagulant drugs make the blood less likely to form clots. Warfarin has been the mainstay of anticoagulant therapy for more than 60 years. New oral anticoagulants include dabigatran (Pradax), rivaroxaban (Xarelto), and apixaban¹ (Eliquis).

Issues

Warfarin is effective in preventing strokes and other blood clots in patients with AFib, but there are some challenges with warfarin therapy. Warfarin doses must be personalized, and regular blood tests are needed to ensure correct dosing.

New oral anticoagulants are given in fixed doses, so routine blood tests and personalized dosing are not needed.

Methods

An expert committee made recommendations on new oral anticoagulants. The recommendations were based on a systematic review and network meta-analysis of the clinical evidence of these drugs, as well as an economic analysis of their cost-effectiveness.

Research Results

Compared with warfarin, the benefits of new oral anticoagulants are small. The estimated number of patients who would avoid a stroke or other blood clot if treated with a new drug rather than warfarin was 2 to 6 people for every 1,000 patients treated per year.

Bleeding risks for patients treated with the newer drugs compared with warfarin were similar overall, with a modest decrease in intracranial bleeding and a small increase in gastrointestinal bleeding. A systematic review showed that there is no reversal agent or proven management strategy if bleeding occurs with the new drugs. The cost-effectiveness of the new drugs was uncertain.

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