New ESC guidelines on atrial fibrillation accept reality of next generation of anti-coagulants

摘要

'The development of dabigatran and the first results from the use of the novel anticoagulant in the RE-LY trial mark an extremely important time in medical history; the first time in 75 years that physicians have agents that are better than the extremely effective warfarin in secondary stroke prevention.' Speaking at the 2012 European Society of Cardiology (ESC) congress in Munich, Germany, Prof Hans-Christoph Diener, Department of Neurology, University of Duisburg-Essen, Germany, also referred to the daily reality of poor warfarin control with low 1NR values resulting in intracranial bleeds. 'In fact warfarin, despite its efficacy when INR levels are well controlled (INR 2-3), due to its very unpredictable pharmacokinetic and pharmacodynamic profile, might not have been approved if the novel anticoagulants were first on the scene and warfarin second.' The conclusion that the new anticoagulants are superior to warfarin in stroke prevention, with a reduced risk of intracranial bleeds, is now part of the reality of the new ESC guidelines in stroke prevention.