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A comparison of blood thinners used to avoid formation of blood clots for patients with atrial fibrillation (AF) found strong support for the use of one blood thinner over another commonly prescribed medication.

Atrial fibrillation occurs when the upper chambers of the heart beat out of rhythm with the lower chambers of the heart.  While AF may cause no symptoms, it can also cause shortness of breath, heart palpitations, and weakness.  The out-of-sync rhythm can cause blood to pool in the upper chamber of the heart and form a blood clot.  In time, the clot may break down or break off and travel from the heart to other parts of the body including the legs, kidney, colon, or the brain—where the clot may cause a stroke.

According to the Centers for Disease Control and Prevention (CDC), AF or AFib is the most common form of treated heart arrhythmia and leads to approximately 450,000 hospitalizations each year and contributes to 158,000 deaths annually.  Risk factors for AFib include high blood pressure, age, obesity, diabetes, and cardiovascular disease, among others.

Medications are commonly used to manage irregular heart rhythms and thin blood to prevent blood clots.  A recent study published in the Annals of Internal Medicine looked at the effectiveness of two drugs commonly used to reduce stroke and embolism risk in patients with AFib or valvular heart disease (VHD).  The focus of the study were the two most commonly prescribed drugs for AFib and VHD, apixaban and rivaroxaban.

Researchers at the University of Pennsylvania Medical school analyzed patient data in a large commercial health insurance database between January 1, 2013 and December 31, 2020.   Some of the study findings include:

  • Patients taking apixaban had a 43 percent lower risk of a clotting event than patients taking rivaroxaban.
  • Similarly, apixaban patients had a 49 percent lower risk of intracranial or gastrointestinal bleed.
  • In reviewing the health records, the differences quickly became apparent. Patients prescribed rivaroxaban had more strokes and other impacts within six months and the 12 months following.

Senior author Dr. Sean Hennessey said, “Until evidence from randomized controlled trials becomes available, we believe clinicians should consider our findings when selecting anticoagulants in patients with AF and VHD.”

Medication choices are largely out of the hands of patients with serious conditions.  Patients necessarily trust their provider to make the best choice.  While it doesn’t hurt to ask your provider if they are up-to-date on recent research—it could hurt if you do not.

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