CCMS Medicine Summer 2017 - 9

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Over the last decade an array of new drugs have been approved
and between generic and trade names there is even confusion for
health care personnel to differentiate between various agents. We
have listed all of the oral antithrombin agents; it is important to
differentiate between oral antiplatelet agents whose function is
mainly in coronary artery disease, post acute coronary syndrome,
and angioplasty; and anticoagulants which are used for AF.
In the majority of patients with non-valvular AF, anticoagulants
are needed; rarely is aspirin alone sufficient.
Warfarin is an old anticoagulant but effective and cheap, and
has been around since 1955.

We have given meta-analysis of newer oral anticoagulants
versus warfarin in stroke or systemic embolism in the above image.
The safety risk of these drugs is also better and exhibited in the
below image.

The other four anticoagulants have been developed within the
last eight years. We have listed above each of their years of approval
and the trials that led to their approval; they're only approved for
non-valvular AF. Warfarin is the only drug approved for valvular
AF and in mechanical valves.
The current guidelines for the anticoagulant management of
AF is based on CHA2DS2-VASc score. It is a point system which
shows an escalating risk of score depending on the number of
points that the patient has; this model is exhibited in the image
below. The acronym is used to describe the risks which include
CHF, hypertension, age over 65, diabetes, stroke, vascular disease,
and gender.
Continued on next page >

The newer agents reduce the mortality, as well as stroke, as
compared to warfarin and they are similar or better in reducing
bleeding risk.

SUMMER 2017 | CHESTER COUNT Y Medicine 9


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Table of Contents for the Digital Edition of CCMS Medicine Summer 2017

CCMS Medicine Summer 2017 - 1
CCMS Medicine Summer 2017 - 2
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