"We have this old drug that is well-tested and been on the market for decades, [and] we have these new medications that don't have the same length of track record, but in large studies, they have very good safety and efficacy data and they decrease some of the Achille's heels of warfarin," he said. "We won't lose anything in stroke prevention and we will gain on these other fronts."
Dr. Ranjit Suri, the director of the Electrophysiology Service and Cardiac Arrhythmia Center at Lenox Hill Hospital in New York City, said that "we are excited to have alternatives to warfarin, and the simplicity of use is attractive because there is less need for monitoring and it is probably as effective as warfarin."
This new agent may be the best choice for individuals at risk for intracranial hemorrhage due to personal or family history of stroke and/or other factors, as well as who have a hard time getting their INR in check.
But there are some unknowns, Suri warned. Vitamin K is an antidote to warfarin in the event of an overdose, but there are no known antidotes to the new drugs yet -- a caution that del Zoppo also mentioned.
And then there's cost: del Zoppo worries that the newer medications, including rivaroxaban, may also be prohibitively expensive.
The American Heart Association provides information about arrhythmia.
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