Atrial Fibrillation (AF) and Atrial Flutter (AFL) are common heart rhythm disorders that can increase the risk of various health complications. An estimated 2.2% of the general practice patient population in Australia in 2019 were diagnosed with AF. Potential health risks associated with AF include:
- Stroke: In atrial fibrillation, the irregular heartbeats can cause blood to pool in your heart and form clots, which may travel to your brain leading to a stroke.
- Heart failure: Over time, the fast and chaotic rhythms caused by AF and AFL can weaken the heart muscles resulting in an inability to pump enough blood into circulation causing symptoms of heart failure such as shortness of breath and fluid retention.
- Other complications: Other possible complications include chronic fatigue due to insufficient oxygen supply from poor circulation, additional arrhythmias or cardiac conditions, and increased likelihood of hospitalisation.
Having AF or AFL does not mean life stops altogether but it may pose significant impacts upon your quality of living.
Current management of AF with anticoagulation
Anticoagulants (also known colloquially as ‘blood thinners’) have been used for many years to manage atrial fibrillation because they help prevent clot formation. This reduces the risk of stroke significantly. Currently, there are two main types of anticoagulants that could be prescribed by doctors depending on an individual patient’s needs:
- Warfarin: This is an older medication which has been widely used for decades but requires regular monitoring through blood tests and compliance with certain dietary restrictions.
- Direct oral anticoagulants (DOACs): These medications such as rivaroxaban (Xarelto), apixaban (Eliquis) and dabigatran (Pradaxa) are Factor Xa inhibitors. They have a major advantage over warfarin as they don’t require regular monitoring by blood testing, increasing medication compliance and reducing clinic visits.
However, DOACs come with their own set of risks including increased bleeding problems. Fear of the risk of bleeding may also restrain doctors from prescribing them and prevents patients with AF from taking anticoagulation therapy to reduce the risk of adverse events such as strokes. This undertreatment or withheld treatment of people with AF makes it necessary to develop new treatments that prevents stroke and systemic embolism.
New class of anticoagulants under study – FXIa inhibitors
A new class of anticoagulants (known as Factor XIa (FXIa) inhibitors) is being developed that may have clinical benefits in patients with AF. In medical terms, FXIa inhibitors have the potential to reduce thrombin generation to prevent clot formation and embolism, thus reducing the risk of stroke in patients with AF without significantly impairing normal haemostasis (stopping bleeding).
While current Factor Xa inhibitors like apixaban block two pathways that stop bleeding (the tissue factor-activated coagulation process and the ‘intrinsic pathway’), Factor XIa inhibits clot formation only through the ‘intrinsic pathway’, which may allow haemostasis to occur normally.
Simply put, Factor XIa inhibitors have the potential to be safer than the Factor Xa inhibitors that doctors are currently using to treat AF.
We are currently recruiting participants for a new study to evaluate the efficacy of a new FXIa inhibitor compared with a Factor Xa inhibitor. This study hopes to demonstrate a reduced risk of bleeding while reducing stroke and systemic embolism events at least as well as the current therapies.
For further information, please visit: Atrial Fibrillation Treatment – Current Studies
Alternatively, you can contact us on 1300 190 841 or email us at info@austrials.com.au