Less is more in atrial fibrillation stroke prevention — please, drop the aspirin

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A recent study in the Journal of the American College of Cardiology shed more light on the commonly used drug combination of aspirin and a vitamin-K antagonist (such as warfarin).  It was a small registry study from one region of France but I believe it offered confirmatory evidence against this dangerous practice. Investigators followed patients […]

Is it safe to take aspirin and warfarin together?

The ultimate goal in medicine: protect the patient from stroke. Even a heart doctor has to admit the dominance of the human brain. Always think about preventing stroke. It’s one of the worst outcomes that can happen to a person. Life as a ‘normal’ human requires a healthy brain. A stroke irreversibly kills off part […]

Apixaban (Eliquis) gets FDA approval

Yesterday afternoon, the FDA finally approved apixaban (Eliquis) for the prevention of stroke in patients with non-valvular atrial fibrillation. I use the words ‘finally approved’ because the markedly positive ARISTOTLE trial was published 15 months ago in the New England Journal of Medicine. The long delay was mysterious. On paper, apixaban looks to be the […]

Let there be three…

You can mark August 2011 as an amazing month for news in the treatment of atrial fibrillation (AF). In this post, I will attempt to share what I have learned about the two new blood-thinning drugs, apixaban and rivaroxaban–both Factor Xa inhibitors. (Disclaimer: this is not a book chapter, rather a blog post from a […]

Rivaroxaban: The next non-warfarin oral blood thinner


The unrelenting epidemic of inactivity and excessive eating wreaks havoc on more than just the heart and blood vessels. Lugging around extra weight also breaks down the joints and back. For evidence, look no further than the waiting room of any orthopedist; the people waiting for joint replacements look the same as those waiting to […]

Warfarin-replacement parade gets crowded

The dabigatran party isn’t even cleaned-up yet, when another warfarin competitor has hit the press wires. As reported on Cardiobrief from a Bayer press release, Rivaroxaban (Xarelto) was as effective as warfarin in stroke prevention in patients’ with AF. A composite of major and minor bleeding events were also similar to warfarin. Rivaroxaban is a […]

A coumadin substitute, we are almost there…

I have heard this for years, “Doc, that stuff is rat poison!” But only lately have I heard this, “Doctor M, that company who can’t talk about their drug brought lunch again today.” Well, it is finally here (well almost), the first warfarin substitute, dabigatran. Sine antiquity, or at least it seems that long, the blood […]

Dabigatran excitement is building…

This morning I am told, “Dr Mandrola, there are two ladies from this company, Boehinger Ingelheim, who need to to give you a secret, sealed envelope.”   I wonder whether the department of Health and Human Services knows about this exciting new potential warfarin substitute.  Surely they do, as replacing the ubiquitous blood thinner warfarin with […]

Does God care that warfarin can have adverse effects?

Is there a flawless medical therapy: a “wonder-drug” devoid of adverse effects, or a procedure without complications? Of course not. It’s why we have clinical trials.  An intervention for a disease is determined beneficial or not by a clinical trial–the new treatment versus no treatment, or the current treatment.  It really is that simple.   […]

Warfarin as a life-saver…

In cancer treatment, detection of a tumor in an early stage markedly increases the chance of favorable outcomes.   Can the much-maligned blood thinner, warfarin, occasionally help in early detection of cancer? Few pharmacologic agents receive more bad press than warfarin.  Stories, which are too numerous to count, like “Did warfarin kill my father,” can […]

Dabigatran: Finally a substitute for the dreaded coumadin is close…

Much energy in previous posts have centered on the ablation of heart rhythm disturbances.  Navigating a GPS guided catheter through the beating heart, triangulating the source of the ectopic impulse, and then delivering a cautery-like RF lesion is fun to do, gratifying to all involved, and makes for decent writing topics. However cool ablation is […]