survey of widely used drug in atrial fibrillation

1. A GENERAL SURVEY ABOUT THE USE
OF DRUG IN ATRIAL FIBRILLATION
PREPARED BY:- ARCHI HITESH PATEL

2. INTRODUCTION
 Atrial fibrillation (AF or A-fib) is an abnormal heart rhythm (arrhythmia) characterized by rapid and
irregular beating of the atrial chambers of the heart.
 It often begins as short periods of abnormal beating, which become longer or continuous over time. It may also
start as other forms of arrhythmia such as atrial flutter that then transform into AF.
 Episodes can be asymptomatic.
 Symptomatic episodes may involve heart palpitations, fainting, light-headedness, shortness of breath, or chest
pain.
 Atrial fibrillation is associated with an increased risk of heart failure, dementia, and stroke. It is a type of
supraventricular tachycardia. 1
2

3. EPIDEMIOLOGY
 The worldwide prevalence of
atrial fibrillation is 37,574 million
cases (0.51% of worldwide
population), increased also by
33% during the last 20 years.
 The highest burden is seen in
countries with high socio-
demographic index, though the
largest recent increased occurred
in middle socio-demographic
index countries. 1
3

4. CAUSES OF ATRIAL FIBRILLATION
 Age: The older a person is, the higher their risk of Atrail fibrillation.
 Hypertension: Long-term high blood pressure can add strain to the heart and increase the risk of Atrial
fibrillation.
 Pulmonary embolism: A blood clot in the lung may increase the risk of Atrial fibrillation.
 Heart disease: People with underlying heart conditions have a higher risk of Atrial-fibrillation. These conditions
include: heart valve disease, Heart failure, Coronary artery disease
 Excessive alcohol consumption: Heavy alcohol consumption can increase a person’s risk of developing Atrial
fibrillation.
 Family members with A-fib: People with a family history of Atrial-fibrillation may be more likely to experience
the condition themselves.
 Other chronic conditions: Other long-term medical problems — including thyroid problems, asthma, diabetes,
and obesity — may contribute to the risk of Atrial-fibrillation. 2
4

5. SIGN AND SYMPTOMS OF ATRIAL FIBRILLATION
 Heart palpitations (feeling that your heart is racing or fluttering)
 Awareness that the heart is beating.
 Chest pain, pressure, or discomfort.
 Abdominal pain.
 Shortness of breath.
 Light-headedness.
 Fatigue or lack of energy.
 Exercise intolerance 2
5

6. COMPLICATIONS OF ATRIAL FIBRILLATION
 If untreated, after a prolonged period it may lead to complications such as:
 Blood clot formation in the heart
 Dislocation of blood clot from heart to other organs such as lungs or brain
 Stroke
 Heart failure
 Chronic fatigue
 Other heart problems
 Abnormal or reduced blood supply to organs 2
6

7. PREVENTATION OF ATRIAL FIBRILLATION
 Managing the diet
 Avoiding consumption of harmful substances
 Avoid Stress
 Exercising
 Stay hydrated 3
7

8. DIAGNOSIS OF ATRIAL FIBRILLATION
 Screening
 Minimal evaluation
 History and physical examination
 Routine bloodwork
 Electrocardiogram
 Echocardiography
 Extended evaluation
 Chest X-ray
 Ambulatory Holter monitoring
 Exercise stress testing 3
8

9. TREATMENT USE IN ATRIAL FIBRILLATION
Mainly used drugs are :-
Anti- arrhythmic Drug - Amidarone ,Flecainide,Lidocaine
Anti-platelets- Asprin,Clopidogrel ,
Anti-coagulant – Heparin,Warfarin, Rivaroxaban,
Calcium Channel blockers – Verapamil,Felodipine
Beta-blockers – Metoprolol,Atenolol
9

10. REVIEW OF LITERATURE
10

11. ANTI-COAGULANT
 Anticoagulants, commonly known as blood thinners, are chemical substances
that prevent or reduce coagulation of blood, prolonging the clotting time.
 The use of anticoagulants is a decision based upon the risks and benefits of
anticoagulation.
 The biggest risk of anticoagulation therapy is the increased risk of bleeding.
 In Healthy people, the increased risk of bleeding is minimal, but those who have
had recent surgery, cerebral aneurysms, and other conditions may have too great
of risk of bleeding. 4
11

12. CLASSIFICATION
12

13. MECHANISM OF ACTION OF ANTICOAGULANTS
13

14. Medical uses
 Atrial fibrillation
 Myocardial Infraction
 Ischemic Stroke
 Deep vein thrombosis
 Coronary Artery diseases
 Cardiopulmonary Bypass[4]
Adverse effect
 Bleeding
• Subcutaneous bleeding
• Blood in stool
• Bleeding gums
• Nosebleeds
• Bruising
 Non-haemorrhagic[4]
14

15. ANTIPLATELETS
 Anticoagulants are closely related to antiplatelet drugs.
 Antiplatelets are group of medicines that stop blood cells (called platelets) from sticking
together and forming a blood clot.
 They are effective in the arterial circulation where anticoagulants have little effect.
 They are widely used in primary and secondary prevention of thrombotic cerebrovascular or
cardiovascular disease. 4
15

16. MECHANISM OF ACTION OF ANTIPLATELETS
16

17. CLASSIFICATION
17

18. Medical Uses
 Coronary artery disease
 Heart attack
 Angina (chest pain)
 Stroke and transient ischemic attacks (TIAs)
 Peripheral artery disease
 Atrial fibrillation
 After angioplasty and stent placement
 After heart bypass or valve replacement surgery 5
Adverse effect
 Headaches or dizziness.
 Nausea.
 diarrhoea or constipation.
 Indigestion (dyspepsia)
 Stomach ache or abdominal pain.
 Nosebleeds. 5
18

19. AIM & OBJECTIVE :-
 Aim :- A General survey about the use of anticoagulant and antiplatelet drugs in Atrial
Fibrillation.
 Objective :- To prevent various complications like
 Blood clot formation in the heart
 Dislocation of blood clot from heart to other organs such as lungs or brain
 Stroke
 Heart failure
 Chronic fatigue
 Other heart problems
 Abnormal or reduced blood supply to organs
19

20. WORK DONE
Patient History : Age: above 40 years & Patients having history of
atrial fibrillation.
Prescriptions are collected based on the above patient history
20

21. RESULT ABOUT THE USE OF DRUGS USED IN ATRIAL
FIBRILLATION
Ecosprin
60%
Warfarin
20%
Heparin
5%
Dabigatran
10%
Rivaroxaban
5%
21

22. COST OF DRUG
 Ecosprin – Ecosprin 150 mg Tablet – 7 Rupee
 Warfarin – Warfarin Tablet 1mg – 26 Rupee
 Heparin – Heparin 25000IU Injection – 188 Rupee
 Dabigatran – Pradaxa 110 mg Capsule – 574 Rupee
 Rivaroxban – Xarelto 10 mg Tablet – 812 Rupee
22

23. DISCUSSION
 Based on collection of Prescriptions it is concluded that drugs especially that prevent clot and platelets
aggregation in atrial fibrillation are Anticoagulant and Antiplatelets to prevent various complications of
atrial fibrillation like stroke and systemic coagulation to avoid mortality and morbidity.
 According to our survey we have concluded that widely used antiplatelets drug in atrial fibrillation is
Ecosprin with 60% and widely used anticoagulant is Warfarin With 20%. Moreover, other
anticoagulant drugs namely: Heparin (5%), Dabigatran (10%) and Rivaroxaban (5%) used in atrial
fibrillation.
 Also, overall the cost effectiveness was studied and it was concluded that cost of newer DOAC like
Rivaroxaban, Dabigatran is higher as compared to Warfarin and Heparin though the safety and efficacy
of newer DOAC is more Warfarin and Heparin. It was observed that Low Mol Wt Heparin was used as
an alternative to Warfarin.
 Apart from this it was concluded for the use of newer drugs like Rivaroxaban and Dabigatran that
Dabigatran is more safe to use than Rivaroxaban as it lowers the risk of Bleeding.
 Also it was analysed that use of Aspirin and Clopidogrel combination is more effective to reduce the risk
of Stroke than Aspirin alone. The use of Aspirin or Aspirin Clopidogrel combination can be useful to
reduce risk of major bleeding. 23

24. CONCLUSION
 Effectiveness of Anti-coagulant and Anti-platelets is as follows:
 Newer Direct oral Anti-coagulant Drugs (DOAC) is greater than other anti-coagulants and antiplatelets.
 Hence it is concluded that safety and Efficacy is as follows:
Dabigatran > Rivaroxaban > Warfarin >Heparin > Aspirin
 But the cost of these Newer drugs like Dabigatran , Rivaroxaban is high so the use of these drugs is less as
compared to other agents like Warfarin and Aspirin.
24

25. REFERENCE
1. .Treatments for stroke prevention in atrial fibrillation: A network meta-analysis and indirect comparisons
versus dabigatran etexilate Neil S. Roskell et al., Thrombosis and Haemostasis, 2010
2. .Cost-effectiveness of dabigatran etexilate for the prevention of stroke and systemic embolism in atrial
fibrillation: A Canadian payer perspective Sonja V. Sorensen et al., Thrombosis and Haemostasis, 2011
3. Choudhury A, Lip GYH. Atrial fibrillation and the hypercoagulable state: from basic science to clinical practice.
Pathophysiol Haemost Thromb. 2003Sep-2004
4. Warfarin and Beyond: An Update On Oral Anticoagulation Therapy Tricia M. Russell et al., US Pharmacist,
2011
5. Morrow DA, de Lemos JA. Stable ischemic heart disease. In: Zipes DP, Libby P, Bonow RO, Mann DL,
Tomaselli GF, Braunwald E, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 11th ed.
Philadelphia, PA: Elsevier; 2019
6. The American Journal of Medicine, Volume Systematic Review and Meta-analysis of Adverse Events of Low-
dose Aspirin and Clopidogrel in Randomized Controlled Trials Retrieved 2013
25

26. 26