ESC Wrap Up - The End Of The Road For Warfarin In AF?

I thought I'd finish the coverage of ESC by discussing briefly 2 studies that were part of the congress and asking for your opinion.

First, there were further data released from the RE-LY study, covered in depth over at HeartWire - here. This study compared a new oral anticoagulant, dibigatran, head-to-head with warfarin in patients with atrial fibrillation. The results showed that the new drug was non-inferior at low dose and superior at high dose in reducing the number of strokes in the population studied, regardless of the INR control achieved with warfarin. This was a post-hoc analysis from the main study of over 18,000 subjects.

Second, today, there was new data from a competitor product, apixaban, in the same patient group although not directly against warfarin, but against aspirin. The new agent was successful at lowering risk of stroke and systemic embolus (by 34%) without excessive bleeding risk. Head to head studies against warfarin are underway (ARISTOTLE study - reports in 2011).

Is the writing on the wall for warfarin in atrial fibrillation? We don't yet know how the newer drugs will stack up against warfarin for those with rheumatic heart disease and AF. But the ease of use and low bleeding rates will certainly be very attractive to clinicians once the drugs come to the marketplace. Presumably more patients will receive these drugs than currently get warfarin, because of the perceived problems (bleeding, monitoring, drug interactions) with warfarin use.

What do you think? Are you eagerly awaiting warfarin replacements? Or is more evidence required?