Study: New Anticlotting Drug Beats Warfarin
Eliquis More Effective at Preventing Strokes in Patients With Atrial Fibrillation
Pros and Cons of New Drugs continued...
For example, Xarelto worked at least as well as warfarin at preventing strokes. But unlike Eliquis, it did not improve survival. And the major study upon which approval of Pradaxa was based showed that drug was associated with higher rates of heart attack and stomach bleeds than warfarin.
But Pradaxa is the only drug to lower the rate of ischemic stroke, the type of stroke caused by blood clots, compared with warfarin. And while the other drugs have to be taken twice daily, Xarelto only has to be taken once a day, increasing the chance patients will take their medication as prescribed, Brindis says.
Another new anticlotting drug, edoxaban, is being tested in a different study, called the ENGAGE study.
Brindis notes that all the newer agents have some potential downsides.
For starters, warfarin is available generically for $4 a month, while Pradaxa can cost $160 a month.
And while doctors can give vitamin K to quickly reverse the effects of warfarin in the case of dangerous bleeding, there's no quick antidote for bleeding caused by the newer agents, he says.
"That's not a trivial issue. The rate of major bleeds in patients on anticlotting drugs is 2% to 3% per year," Brindis says.
Brindis and Bohm agree that the newer agents will probably prove most useful for patients being prescribed anticlotting drugs for the first time and those for whom warfarin dosing proves problematic.
"If warfarin has been working with no problems, and the patient isn't all upset about the blood work, there is no reason to switch," Brindis explains.
The Eliquis study, dubbed Aristotle, was funded by Bristol-Myers Squibb and Pfizer. Bristol-Myers said an application for approving Eliquis for AF will be filed with the FDA later this year.