As Rivaroxaban Challenges Warfarin for Stroke Prevention with AFib, Cardiovascular Nurses Play Key Role in Patient Education

(Madison, Wis.) Today the results of research on yet another blood thinning medicine in patients with atrial fibrillation are being published. If approved for use in these patients by the FDA at an upcoming meeting, there will be another option for preventing stroke in patients with atrial fibrillation. Cardiovascular nurses continue to be the main source of patient understanding of atrial fibrillation and medication options.

Lynne Braun, PhD, CNP, CLS, FAHA, FPCNA, FAAN; PCNA Board of Directors

Atrial fibrillation, or A Fib, is the leading arrhythmia in the United States, affecting more than 2.2 million Americans. The risk of developing atrial fibrillation increases sharply with age, as the prevalence of atrial fibrillation is 10% in persons 80 years or older. One-fourth of adults aged 40 years and older will develop atrial fibrillation during their lifetime.

Depending on age and other health problems, patients with atrial fibrillation can be at increased risk for stroke, a risk that can be 2-7 times higher than the risk in patients with normal heart rhythm.

The risk of stroke can be greatly reduced in at-risk patients by the administration of blood thinning medications. These powerful medications can help prevent clots from forming in the heart and traveling to the brain where they can block a blood vessel and deprive part of the brain of its blood supply, causing a stroke. Until recently, Warfarin (trade name Coumadin) was the only oral anticoagulant (blood thinning medication) for patients with A Fib. While very effective, Warfarin must be very carefully managed. Each patient's dosage requirement is different, and the right dose can change (up to every month) in the same patient depending on their diet and what other medicines they are taking.

Last October, a new anticoagulant medication, Dabigatran (Pradaxa) was approved for use in the United States for patients with non-valvular atrial fibrillation. This medicine does not require the regular blood tests that Warfarin does. Because it is a new medication, it is, of course, more expensive than Warfarin, which is available in generic form. However, it represents an option that health care providers may choose in some patients.

Today, the results of research on yet another blood thinning medicine in patients with (non-valvular) atrial fibrillation was published. This new drug, Rivaroxaban (Xarelto) is shown to work as well as Warfarin in preventing stroke in patients with atrial fibrillation. It is also at least as safe as Warfarin in terms of bleeding complications.

In September, the manufacturer of this medication will be meeting with an FDA advisory committee to ask that this medication be approved for use in patients with atrial fibrillation. It is already approved for use in preventing blood clots in the legs and lungs of patients who are having knee or hip replacement surgery.

Patients taking any one of these powerful blood thinners need to work very closely with their health care team to understand the benefits and risks associated with taking these medicines, and also the risk associated with not taking them, such as strokes.

Cardiovascular nurses, in hospitals and office settings play a major role in educating patients, and engaging patients to a play an active role in managing their health so that they can live as active and high quality life as possible. The Preventive Cardiovascular Nurses Association (PCNA) is a primary source for providing education, tools and support to cardiovascular nurses and advanced practice nurses to better educate patients and impact patient outcomes.

The organization develops five to ten patient education pieces per year on issues that urge patients to play an active role in managing their health and medications. This fall, they will introduce a new patient booklet on how to manage atrial fibrillation. In an effort for their materials to be more effective for patients, PCNA also follows strict low literacy guidelines.