"It's premature to say that a drug like dabigatran will take the place of warfarin," Gersh said. "There will be a lot of discussion about cost and convenience. It's a twice-daily dose and there are some questions about a possible higher rate of heart attack. I don't think this is truly resolved yet, but I think we can say that for the first time we have seen a drug that certainly has the potential to be an alternative to warfarin, and maybe even superior."
Two other trials, both presented at the heart association meeting and published in the Nov. 18 issue of Circulation, looked at an anti-clotting pill called ticagrelor (Brilinta), comparing its performance with clopidogrel (Plavix). Brilinta, made by AstraZeneca, is also awaiting approval from the U.S. Food and Drug Administration.
Prior Brilinta studies found that it was better than Plavix in preventing new heart attacks and preventing deaths among patients who had already had a heart attack.
In the first of the two latest trials, both conducted by researchers at Sinai Hospital in Baltimore, 123 patients with stable coronary artery disease who were also taking aspirin were randomized to Brilinta, Plavix or a placebo for six weeks.
Brilinta evoked a response in patients who did not respond to Plavix. It also could be turned off faster, meaning patients could go into surgery right away if needed, and lasted longer.
The second Brilinta study showed that 98 patients who didn't respond to Plavix did respond to Brilinta.
All of this just signals the beginning of a new round of anti-clotting medications, experts said.
"There are several trials ongoing of other alternatives to warfarin. We will probably see results in the next two years," Gersh said.
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