Commonly known by the brand name Coumadin, warfarin is an anticoagulant drug that is no longer recommended for treating atrial fibrillation (Afib), except for a few selected group of patients, according to the new guidelines laid on Monday by the American College of Cardiology and the American Heart Association.
Instead, physician and patients are advised to use “novel oral anticoagulants” (NOACs) that have been approved by the U.S. Food and Drug Administration (FDA).
Most of the latest recommendations for Afib remain the same as the last version that was issued in 2014. However, other important changes in the 2019 update are starting blood thinners at early or lower stages of the disease and encouraging people to focus on lifestyle changes such as weight loss.
More than 6 million Americans have some type of Afib. About 2% of people under 65 years of age and 9% of those above 65 years of age experience signs and symptoms of Afib, which is why it is one of the most common types of arrhythmias, according to the CDC.
Dr. Craig January, renowned cardiologist at the University of Wisconsin said, “It becomes an even bigger problem as people age into their 70s and 80s.” “So the numbers of people affected by Afib will go up a great deal in our society as the population of baby boomers age.” He was the lead writer for the guidelines laid in both 2014 and 2019.
Understanding Afib
Patients with atrial fibrillation experience the sensation of flutter in their chest; they describe the sensation of quivering rather than beating, while some patients experience uncomfortable flip-flop.
Such types of sensations happen when the heart’s upper chambers receive chaotic electrical signals, which then begin to shudder. Eventually, the connection to the heart’s lower chambers is bombarded by impulses, causing that area to beat more quickly but out of sync with the rest of the heart. In the middle of such episode, one can have heart rates ranging from 100 to 175 beats per minute.
Dr. January explained that while the heart is beating rapidly, it does not contract properly, letting blood to pool in the left atrial appendage, a small ear-shaped sac present in the heart’s left upper chamber muscle wall. This pooling can make the blood thick when it is released, producing a clot that can go anywhere in the body. More often than not, the blood clot may end up in the brain, causing a stroke. This is the reason why patients with atrial fibrillation are five times more likely to get a stroke.
Using blood thinner becomes key
The new guidelines released in 2019 continue to stress the use of blood thinners for Afib, but with one major change.
Dr. January said, “In 2014, we recommended the use of warfarin and NOACs, but we didn’t prioritize one over the other.” “We are now saying that in some patients, NOACs are better than warfarin.”
As there is a lack of research on the efficacy of NOACs v/s warfarin, the new guidelines suggest that patients with mechanical heart valves and mitral stenosis (narrowing of the mitral valve opening) should continue taking warfarin.
However, for other patients, the use of NOACs are encouraged, such as Pradaxa (dabigatran), Eliquis (apixaban), Xarelto (rivaroxaban), and Savaysa (edoxaban).
The cardiologist added, “NOACS are better at preventing stroke and have fewer side effects.” “NOACs are not free of side effects, but compared to warfarin, it’s easier to manage.”
There are many factors affecting warfarin’s impact. People who use the drug must be monitored through blood tests regularly (every three months) to avoid the risk of excessive bleeding or clotting. Such interactions become very common as people age, increasing the frequency of blood tests at least once a week.
On the other hand, the newer types of blood thinners do not require such intensive monitoring, explained Dr. January. He further went on to say, “With NOACs, you don’t measure or draw blood.” “Once a year, you do a kidney and liver function test, because that’s where they are metabolized.”
In addition, there are FDA-approved reversal drugs for most of the NOACs, which will rapidly reduce their anti-clotting effects in cases of excessive bleeding, the cardiologist explained.
The writer of the new guidelines stated, “Risk factors for Afib also include diabetes and obesity. That’s why, for the first time, the guidelines have a section on weight management.”
Studies have shown that eating a heart-healthy diet, including the Mediterranean diet, improves heart health. Several studies have also found that the Mediterranean diet has the ability to reduce the risk of high cholesterol, diabetes, dementia, depression, and even breast cancer. Remember, a heart-healthy lifestyle is about not only diet but also other factors – such as exercise, quit smoking, limiting caffeine and alcohol, and managing stress.
