Novel oral anticoagulants (NOAC) have been found to minimise the risk of stroke in patients with atrial fibrillation (AF) to a large extent. While the Western world has replaced the older drugs with NOAC, the Government of India has reduced the cost of one of the three drugs currently being prescribed in the country by one-third.
“Stroke prevention is a tough job. AF, which is irregular heart beat, is one of the important causes of stroke,” K. Jaishankar, director and mentor, Cardiology and Electrophysiology, MIOT International, told reporters on Wednesday.
“Stroke occurs when AF causes blood clots to form in the heart, and these clots spread to other organs. Among 100 cases of strokes, 15 to 20% are caused by AF,” he said. For almost five decades, Warfarin, a blood thinner, was used for treating patients, he said. “This had several problems such as food and drug interactions. Patients cannot consume green leafy vegetables. It did not go well if they had fever, cold and cough and it had high risk of bleeding,” he added. In the last 10 years, evidence has emerged that NOACs could minimise the risk of stroke, he added. “These have better efficacy, less bleeding side effects and predictable safety profile. The Western world has replaced Warfarin with these drugs,” he pointed out.
While one of the NOACs, Dabigatran arrived in India nearly four years ago, Apixaban and Rivaroxaban were introduced three years ago. The Government of India has reduced the cost of Dabigatran from ₹75 per tablet to ₹25 now. “So, the cost of a day’s course - consisting of two tablets - has been reduced from ₹150 to ₹50,” he said. NOAC is not advisable during pregnancy and in patients with artificial mechanical heart valves and severe kidney failure, Dr. Jaishankar added.
In line with this, John Eikelboom, associate professor, Division of Haematology and Thromboembolism, McMaster University, delivered a lecture on optimising anticoagulation in AF-translating evidence into clinical practice.