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Anticlotting Drug May Be Alternate to Warfarin

Study Shows Xarelto May Prevent Stroke and Blood Clots

High-Risk Patients

"This was a very high-risk population," making the results even more impressive, Califf says. The average age was about 73, and 44% were 75 or older. More than half of them had already suffered a stroke or mini-stroke known as a transient ischemic attack.

Participants entered the study between December 2006 and May 2010 and were followed for an average of 19 months.

The new findings, combined with those from a recent study showing Xarelto was as safe and effective as warfarin at dissolving potentially deadly blood clots in the legs, is expected to lead to FDA approval of the drug, doctors say.

The study followed patients with atrial fibrillation (AF), a condition characterized by irregular heart rhythms. Many people with atrial fibrillation are more likely to suffer a stroke because their weakened heartbeats allow blood to pool in an upper chamber of the heart. Pooled blood is more likely to form clots, which can travel to the brain and cause a stroke.

Warfarin Drawbacks

Warfarin is the usual treatment to reduce the risk of stroke, but up to half of patients can't take it due to increased bleeding risk or drug interactions, or refuse to take it. If too much is given, you can suffer a dangerous bleed; too little, and you’re at risk for a deadly blood clot. You also have to be careful not to eat too many green leafy vegetables, which can interfere with its action.

Aspirin is sometimes used as a treatment in these patients, but it's less effective. So there's a race on to find a better alternative.

The first of the new anticlotting drugs, Pradaxa, was approved by the FDA last month for the prevention of stroke in patients with AF. In addition to Xarelto, other anticlotting drugs in development include apixaban, edoxaban, and betrixaban.

American Heart Association spokesman Raymond Gibbons, MD, of the Mayo Clinic in Rochester, Minn., tells WebMD that "it's very clear we need alternatives for the millions of Americans who need [anticlotting drugs] for AF."

That said, "Some of my patients do very well on the [much cheaper] warfarin," says Gibbons, who was not involved with the work.

While no price has been set for Xarelto in the U.S., Pradaxa is expected to cost more than $6 per day. Generic warfarin costs much less than $1 a day, although the price of regular blood tests and insurance co-pays needs to be weighed in, Gibbons says.

The drugs are part of a class called Factor Xa inhibitors. They interfere with our body's own clotting mechanism, which, when out of control, can lead to strokes in the setting of AF or clots in the leg that can travel to the lung.

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