Warfarin and its role in the prevention of thromboembolism in atrial fibrillation (lecture)

Abstract

In the article "Antithrombotic therapy in atrial fibrillation: new oral anticoagulants" (Meditsinskiy Sovet, 2014, P. 38--48), the focus was on direct thrombin inhibitors and factor Xa inhibitors. This is quite justified. Currently, there is no doubt that direct oral anticoagulation (AC) for the prevention of thromboembolic events (TE) in general and in particular for ischemic stroke in patients with atrial fibrillation (AF) has a number of significant advantages over the "ancient" vitamin K antagonists. They are well known and listed in the latest Russian guidelines for the treatment of AF. These advantages include comparable efficacy in the prevention of stroke and TE with greater safety against the risk of "large" hemorrhage, particularly hemorrhagic stroke; a trend towards lower mortality; fewer interactions with other drugs and foods; no need for continuous monitoring of blood coagulation parameters. However, no one doubts that in the long-term, we will have to use the old, indirect oral AC, if only because of their low cost compared to the new drugs. However, this is not the only reason why we cannot give up the old ones in the near future. For example, new oral AC can be used only in non-valvular AF. Vitamin K antagonists as supported by stronger evidence base, should be preferred in the treatment of cancer patients. The new oral AC, definitely, "are offensive on all fronts." It is already possible to have cardioversion of AF of 48 or more hours against a background of their administration, and interventional treatment of AF is an option in the near future. In a little while, antidotes to direct oral AC will appear. But patients need treatment right now, today. Therefore, we should not forget how to use the "old" drugs.