Trending Clinical Topic: Warfarin

Ryan Syrek


November 01, 2019

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Results of a study on treatment for atrial fibrillation (AF) and new findings regarding treatment for antiphospholipid syndrome (APS) put a focus on warfarin this week, making it the top trending clinical topic. A study published in the Journal of the American College of Cardiology found that direct-acting oral anticoagulants (DOACs) for AF are associated with a lower risk for osteoporotic fractures compared with warfarin. Results from the 2-year study of more than 37,000 patients with AF found a significantly reduced relative risk for any fracture or for starting on osteoporosis medication. This prompted the authors to conclude that clinicians should consider switching treatments in patients taking warfarin who are at risk for osteoporosis or osteoporotic fractures. However, an accompanying editorial suggested that the choice between warfarin or a DOAC in patients with AF and no prior osteoporotic fracture (the population studied) shouldn't be made on the basis of risk for osteoporotic fracture but on other risks, including ischemic stroke and hemorrhage, as well as the need for monitoring and drug affordability.

Alternatively, a randomized study published in the Annals of Internal Medicine   showed that warfarin was superior to rivaroxaban for anticoagulant treatment used to address thrombosis in patients with APS. In fact, patients with APS who were treated with rivaroxaban demonstrated nearly double the risk for recurrent thrombosis than patients treated with warfarin. One patient in the rivaroxaban group developed catastrophic APS. Proposed guidelines by the European League Against Rheumatism recommend against use of rivaroxaban in patients with triple-positive APS, and these findings appear to support that guidance. These additional pieces of evidence regarding the best approaches for the use of warfarin in different patient groups helped make the drug this week's top trending clinical topic.

Read more about the uses and adverse effects of warfarin.


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