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From The Medical Letter on Drugs and Therapeutics
March 26, 2014

Rethinking Warfarin for Atrial Fibrillation

JAMA. 2014;311(12):1246. doi:10.1001/jama.2014.339

Full-page newspaper advertisements and a series of television commercials have urged patients with atrial fibrillation to “rethink warfarin” in favor of Eliquis (apixaban – Bristol-Myers Squibb). Apixaban is the latest of 3 new oral anticoagulants now competing with warfarin (Coumadin, and others) for the oral anticoagulant market.1

Unlike warfarin, the new oral anticoagulants do not require INR monitoring and have no dietary restrictions. Dabigatran (Pradaxa), rivaroxaban (Xarelto), and apixaban all appear to be at least as effective as warfarin in preventing stroke in patients with nonvalvular atrial fibrillation. In clinical trials,2-4 they each caused less intracranial bleeding than warfarin, and apixaban caused less overall bleeding,5 but the trials were conducted in somewhat different populations and used slightly different definitions of major bleeding.

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