NOACs under-prescribed
December 7, 2015
Australian doctors appear
to be hesitant to prescribe the
recommended dosages of the
various novel anticoagulants
(NOACs), according to the longrunning
GARFIELD study which is
following 57,000 patients across
the globe.
GARFIELD (Global Anticoagulant
Registry in the Field) is initially
looking at patients with newly
diagnosed atrial fibrillation (AF), and
there are 20 Australian clinicians
actively involved in the study.
One of those is cardiologist Harry
Gibbs who presented at a luncheon
convened by Bayer last week in
Sydney, and is a strong advocate
of the use of the NOACs for stroke
prevention in connection with AF.
Gibbs said the figures, as
expected, show a significant spike
in the use of the NOACs following
their PBS approval, but interestingly
some clinicians appear to be
hedging their bets by prescribing
lower doses - perhaps because of
the impression that there is “no
antidote” for them.
However in fact the short half-life
of the NOACs means in the event
that emergency surgery is required
this generally is not an issue, and
moreover in many cases bleeding
events are gastrointestinal which
can be easily treated.
Some doctors prescribe Clexane
as a “safer” alternative to warfarin
and again there’s no reversal agent.
“There are plenty of approaches
to the management of bleeding.
“If I had the choice between a
blood transfusion and having a
stroke I’d take the blood transfusion
every time,” he said.
“We need to do something to
improve the use of anticoagulants
in AF because strokes are really
terrible,” he said.
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