The AFIB Report

Your premier information resource for atrial fibrillation


EDITORIAL

Number 104
November 2010
10th Year



Great news for afibbers with risk factors for stroke on October 20 the FDA approved a replacement for warfarin (Coumadin). Dabigatran etexilate (Pradaxa) is a direct thrombin inhibitor that has been thoroughly evaluated in at least five clinical trials; the most recent being the RE-LY trial involving over 18,000 atrial fibrillation patients with one or more risk factors for ischemic stroke. Dabigatran, at 150 mg twice daily, was found to be more effective than warfarin in protecting against ischemic stroke and embolism, had one quarter the risk of hemorrhagic stroke, but a somewhat higher risk of heart attack. The new drug comes in two dosages 150 mg twice daily for afibbers with normal kidney function, and 75 mg twice daily for those with impaired kidney function. Dabigatran is not recommended for patients with impaired liver function. However, as in the case for warfarin, there is no evidence whatsoever that the drug would be beneficial for lone afibbers with no or, at the most, one moderate risk factor for ischemic stroke.

Among other good news Japanese researchers report that a 3-day course of corticosteroids post-ablation markedly reduces the incidence of AF recurrence both short- and long-term. Success rates for catheter ablation of paroxysmal and persistent AF are steadily rising with an 85% complete success rate (no afib, no antiarrhythmics) for paroxysmal and 78% for persistent being reported by Japanese electrophysiologists. And, especially good news for persistent afibbers undergoing ablation, the success rate for these more difficult cases can be substantially improved by pre-procedure therapy with dofetilide (Tikosyn).

If you have not yet done so, I would encourage you to explore my new AFIB Resources section. Here you will find in-depth information on topics vital to lone afibbers such as dealing with digestive problems, the importance of potassium, post-ablation care, living with warfarin, osteoporosis prevention and treatment, endurance exercise, electrical cardioversion, etc.

Wishing you good health and lots of NSR,

Hans



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