Prescrire international
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Prescrire international · Nov 2012
Randomized Controlled Trial Multicenter StudyAcute coronary syndrome and rivaroxaban: not so fast...
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Prescrire international · Nov 2012
Rivaroxaban and atrial fibrillation: continue to use warfarin or in some cases, dabigatran.
Warfarin, at a dose adjusted according to the INR, is the standard prophylactic anticoagulant for patients with atrial fibrillation and a major risk of thrombosis. Dabigatran, a thrombin inhibitor, is an alternative when warfarin fails to maintain the INR within the therapeutic range most of the time. Warfarin and aspirin are reasonable choices for patients at moderate risk of thrombosis. ⋯ Combination with other antithrombotic drugs should be avoided. In practice, warfarin remains the standard prophylactic drug for patients with atrial fibrillation and a major risk of thrombosis, while dabigatran is an alternative in cases that are difficult to manage. In mid-2012, the data on rivaroxaban are not sufficiently convincing to challenge this standard.