when it’s something else. You should be thinking about what else is going on,” says Professor Sindone, pointing to examples such as myalgia and muscle aches with statins.
“It’s important for pharmacists to not just tell patients not to take a medicine due to an adverse event, but to go talk to their doctor.”
Warfarin, NOACs and real world evidence
There is a need to look at real world evidence in connection to new oral anticoagulants (NOACs), says Professor Sindone.
Atrial fibrillation (AF) is the biggest risk factor for stroke – and in two-thirds of stroke patients, the event was due to AF.
Meanwhile, almost one quarter of those with AF don’t know they have it, and 85% of patients with AF are not adequately anticoagulated.
“In the NOAC world, there’s a lot of inappropriate dosing. There are two risks: stroke and bleeding,” says Professor Sindone.
“Most doctors are scared of bleeding and will underdose – this will give the patient enough to have some effect but not enough to prevent stroke.
“If you ask the patients, most are more scared of having a stroke than of bleeding.”
Professor Sindone says clinical trials have found the NOAC rivaroxaban (Xarelto) leads to a 21% reduction in stroke compared to warfarin.
And real world data shows positive results for the safety profile of rivaroxaban the complements clinical trial findings.
“NOACs have been shown to have similar and maybe superior stroke prevention to warfarin,” he says.
These results have been found in RCTs, with real world evidence reaffirming its efficacy and safety profile.
Professor Sindone reminds pharmacists to be aware that there are risks and benefits to weigh up with NOAC use.
“If someone comes to the pharmacy who has bruising and bleeding because they’re on anticoagulation drugs, remind them of the risk of stroke,” he says.
“[However ultimately] it’s the doctor’s job to explain why they are prescribing a certain medication.”
Disclosure: Professor Sindone has received honoraria, speaker fees, consultancy fees, is a member of advisory boards or has appeared on expert panels for: Alphapharm, Aspen, Astra Zeneca, Bayer, Biotronik, Boehringer Ingelheim, Bristol Myers Squibb, Cube, CSL, HealthEd, Janssen Cilag, Menarini, Merck Sharp and Dohm, Novartis, Pfizer, Roche, Sanofi, Servier and Vifor.