Understanding heart condition atrial fibrillation?

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In May last year, all three drugs — dabigatran (Pradaxa), apixaban (Eliquis) and rivaroxaban (Xarelto) — were approved by the National Institute for Health and Care Excellence (NICE).

As a result, last August the European Society of Cardiology effectively tore up its guidelines and introduced a new test to enable doctors to identify ‘truly low-risk patients’. These people don’t need anticoagulant treatment. But all other atrial fibrillation patients at any risk of stroke should be put on blood-thinning agents, whether warfarin or the new drugs, the organisation has said.

But a year after NICE approval, the drugs are barely prescribed in the UK. This is partly down to cost, says Trudie Lobban. At around £3 a day, they are much more expensive than the pennies that warfarin costs — though it’s a small price to pay compared with the cost of treating strokes.

The main problem is a PR one: over the past year there has been a flurry of litigation in the U.S., particularly around dabigatran, with claims that thousands have been injured or killed by uncontrollable internal bleeding.

Yet the U.S. regulator, the Food and Drug Administration, has confirmed that dabigatran is at least as safe as warfarin.

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