Study author Dr. Manesh R. Patel, an assistant professor of medicine at Duke University School of Medicine in Durham, NC, said that the new agent may be "a reasonable alternative to warfarin, with less intracranial or fatal bleeding." Many people on warfarin need to have their blood monitored to ensure that a blood clotting test known as the International Normalized Ratio (INR) is where it should be, and there are also many dietary restrictions, he noted.
"You can't eat broccoli and other vitamin-K rich foods" on warfarin, Patel said. In contrast, the new drug is taken once daily and has a more consistent effect. "It is a useful alternative with fewer drug-drug and drug-food interactions and may be significantly easier to take," Patel said. If and when the drug is approved to treat atrial fibrillation, doctors will have to develop an appropriate way to transition patients from warfarin to the new drug, he said.
Dr. Gregory J. del Zoppo, a professor of medicine at the University of Washington Harborview Medical Center in Seattle, wrote an accompanying journal editorial. He said that the multiple analyses in the new study had "muddied the waters" regarding rivaroxaban's efficacy. "Some people do well with warfarin and don't complain about one blood draw a month and watch what they eat," he said. "For those folks, warfarin is still the standard."
On the other hand, the new agent may be an option for people who are more difficult to manage on warfarin, he added. "There are a number of people who are difficult to control and for whom the monitoring is complicated and intrusive, and they have to go monthly or weekly to have blood drawn," he said.
Dr. Kousik Krishnan, associate professor of medici
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