Blood Thinners

New blood thinners slightly safer, more convenient, Singapore News & Top Stories - ...
Page 1 of 9
THE STRAITS TIMES

Doc Talk
New blood thinners slightly safer,

more convenient
Ong Hean Yee
 PUBLISHED FEB 28, 2017, 5:00 AM SGT
They are as effective as warfarin and patients need not go for regular
blood tests
One of my patients, Madam Tan, celebrated her 80th birthday a few weeks ago.
Her family doctor, whom she sees regularly for the management of her diabetes and
hypertension, recently discovered that she had an irregular heart rhythm.
However, Madam Tan had no other symptoms, and her blood pressure and blood sugar levels
were well controlled.
She is, in many ways, the perfect patient. She eats in moderation and maintains a healthy
weight. She goes for walks regularly and monitors her blood pressure at home. She is also well
read and aware of the medications she is taking and why.
Her family doctor had correctly diagnosed her with atrial fibrillation, which was confirmed on a
repeat heart trace (electrocardiogram) when I saw her.
Atrial fibrillation is an irregular heart-beat problem that can increase your risk of stroke, heart
failure and other heart-related complications.
http://www.straitstimes.com/singapore/new-blood-thinners-slightly-safer-more-conveni... 2/28/2017
New blood thinners slightly safer, more convenient, Singapore News & Top Stories - ... Page 2 of 9
ST ILLUSTRATION: ADAM LEE
A significant part of the research on Rivaroxaban was carried out in

Singapore. We know that the benefit and safety of the drug are even more
significant among elderly and Asian patients.

It is due to a short circuit in the wiring of the heart. This, in turn, is commonly caused by ageing
and longstanding hypertension (high blood pressure).
It is less commonly caused by hormonal changes or genetic inheritance.
Atrial fibrillation is the most common heart-rhythm problem among Singaporeans of her age. As
many as one in 20 has it.
Yet, more than a third of the patients with this condition are not even aware that they have this
problem. While it is not directly life-threatening, it markedly increases their risk of a major
stroke.
As a cardiologist, I will need to determine if such patients have an associated heart-valve
problem and that their heart function has not been affected by this irregular rhythm.
Madam Tan's heart scan confirmed that her heart function was normal for her age, though she
had a slightly dilated heart chamber (her left atrium, to be precise).
Blood tests showed that she had normal kidney and thyroid hormone function.
Her heart rhythm may be irregular but it is neither too fast nor too slow, as one of her current
medications for hypertension had fortuitously helped to keep her heart rate under control.
Nevertheless, I needed to make sure her risk of a stroke was kept low. Many elderly patients
have told me they are not fearful of death but, rather, of significant disability or pain.
Fortunately, the treatment to prevent strokes has undergone a major revolution in recent years.
Aspirin, which was first derived 100 years ago from an active ingredient found in the bark of the
willow tree, is still a very good treatment for many types of strokes.
However, it will not protect one from a stroke that is caused by atrial fibrillation.
For that, the current standard of care is the use of warfarin, an excellent drug which was first
extracted in the 1950s from sweet clover that had become mouldy.
However, its effectiveness is affected by diet, genetic factors and other medications. In addition,
regular blood tests are required to adjust the dosage for safety and efficacy.
There is now a new class of medications called novel oral anticoagulants (NOAC). These have
been shown to be as effective as warfarin and are slightly safer as there is less risk of serious
bleeding.
Only patients with certain conditions, such as significant kidney problems or mechanical heart
valves, should not use them.
With this new generation of blood thinners, there is no need to go for regular blood tests or to
adjust the dosage.
I had a long discussion with Madam Tan and her family. She was concerned about her high risk
of stroke and was keen to start treatment with warfarin.
She was, however, concerned about the frequent blood tests and visits needed to monitor the
medication.
Her daughter, who usually accompanies her to the clinic, was concerned that she would have to
take time off work and this might affect her job security.
Madam Tan also preferred a once-daily tablet as she might forget to take it in the afternoons.
I, therefore, recommended an NOAC drug. In her case, it was Rivaroxaban, sold under the
Xarelto brand, and she needed to take it only once every morning.
A significant part of the research on Rivaroxaban was carried out in Singapore. We know that
the benefit and safety of the drug are even more significant among elderly and Asian patients.
While the cost of this and other new-generation blood thinners is higher, Madam Tan and her
family felt that the advantages outweighed the cost.
As she does not require very close monitoring, she can continue her regular follow-ups at the
clinic near her home and continue to see her family doctor.
Madam Tan's case also shows the need for regular check-ups with your family doctor.
Research into new and better treatment for Singaporeans is crucial and I am very grateful to my
patients who had volunteered for the research into this class of medications 10 years ago.
Although they did not benefit directly from their contribution, they have helped countless
patients whom they will never meet, like Madam Tan.
•Dr Ong Hean Yee is a senior consultant cardiologist at Cardiac Solutions Medical Centre at
Mount Elizabeth Novena Specialist Centre.
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New blood thinners slightly safer, more convenient, Singapore News & Top Stories - ...

THE STRAITS TIMES

New blood thinners slightly safer,

 PUBLISHED FEB 28, 2017, 5:00 AM SGT

ST ILLUSTRATION: ADAM LEE

A significant part of the research on Rivaroxaban was carried out in

It is less commonly caused by hormonal changes or genetic inheritance.

As a cardiologist, I will need to determine if such patients have an associated heart-valve

MORE FROM THE STRAITS TIMES

YouTube video Husband of Video of teen who Video of joyride

FROM AROUND THE WEB

Woman shot 6 times while driving in Penang: 5 other

Woman shot dead in Penang: Dead in 5 minutes after

Don't underestimate value of studying local literature

Gaming app helps make learning fun

13 old school and new school eats in Aljunied

6 steps to healthier skin, body and mind during period

My 3-day food journey around this paradise called Hong

7 #untaggable destinations to explore in Singapore

What you need to know about Tanah Merah’s newest

Connected city fringe living

Educator Simplifies Personal Data Protection

Kia Niro: The hybrid car to look out for in 2017

Stay tuned for WomansTalk every weekday for exclusive

No More Wet Market Visits! Get Your VEGETABLES In 3 Hrs!

Be Connected To Home Anytime with 360 SMART CAMERA!

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