New double-blind a-fib trial

[kaisardog]

found online: national double blind study and research trial now soliciting a-fib patients: this funded study at a number of major teaching hospitals nationally is to ascertain whether group 1: pt s w/ a hx of a-fib, who are dx d and rx d eliquis by their MD to take daily for life , do better long-term than group 2, pts in the study who are told by MD to take eliquis for only a 30- day period, starting right after an a-fib episode.

is taking eliquis for 30-days only post an a-fib episode as effective as being on eliquis for life?

note the warnings on eliquis say 'do not discontinue this drug w/o MD supervision. '
so this study has patients stop taking eliquis, then only start it up if they have an a-fib episode?

any thoughts ?

 

[E tank]

found online: national double blind study and research trial now soliciting a-fib patients: this funded study at a number of major teaching hospitals nationally is to ascertain whether group 1: pt s w/ a hx of a-fib, who are dx d and rx d eliquis by their MD to take daily for life , do better long-term than group 2, pts in the study who are told by MD to take eliquis for only a 30- day period, starting right after an a-fib episode.

is taking eliquis for 30-days only post an a-fib episode as effective as being on eliquis for life?

note the warnings on eliquis say 'do not discontinue this drug w/o MD supervision. '
so this study has patients stop taking eliquis, then only start it up if they have an a-fib episode?

any thoughts ?

Had to check your last posts to be sure you weren't a robot...doesn't seems so, so I'll chime in. You don't post any links to an actual randomized DBS so I'm still dubious as to the premise of the post...just for starters, that a broad swathe of patients don't even know they're in a fib, not sure how subjective awareness of a fib would be a reasonable trigger for taking a Xa inhibitor....or not taking one...unless a vetted monitoring device (which assumes someone dialed in enough to recognize a fib on an ekg) was being used, this sounds insane given what is at stake, ie debilitating stroke...if legit, def sounds like a European study....

 

[FiremanMike]

Had to check your last posts to be sure you weren't a robot...doesn't seems so, so I'll chime in. You don't post any links to an actual randomized DBS so I'm still dubious as to the premise of the post...just for starters, that a broad swathe of patients don't even know they're in a fib, not sure how subjective awareness of a fib would be a reasonable trigger for taking a Xa inhibitor....or not taking one...unless a vetted monitoring device (which assumes someone dialed in enough to recognize a fib on an ekg) was being used, this sounds insane given what is at stake, ie debilitating stroke...if legit, def sounds like a European study....

I mean it is an interesting question and one I hope is being asked.. a-fib patients were once considered to be anticoagulated for life, but is that just because we’ve always done it that way?

I have encountered several a-fib patients who weren’t anticoagulated, by their own choice, and they weren’t stroking out in front of me. Maybe there is a better way..

Remember dual 14ga IVs with 2 liters going wide open, full spinal immobilization, 15LPM via non rebreather, and MAST pants were once the standard of care for all trauma patients, critical criteria for NREMT if I recall correctly… Then someone finally said “hang on a sec, lets look at this”. I wish this would happen more in medicine. If different countries are doing it differently, what can we learn from them?

 

[E tank]

Yeah, this looks like a call for study subjects without a proposal or abstract so there's no telling what the study design, statistical modeling, methods etc. will be. Just smells like something that would not pass IRB muster in the US, but could in Europe. Having seen many left atrial thrombi (on transesophageal echo) in fib patients taking a Xa inhibitor, using one intermittently just sounds dangerous. Also, this:

is taking eliquis for 30-days only post an a-fib episode as effective as being on eliquis for life?

Doesn't make sense. After the episode of a fib is over? Ongoing? The time frame and conditions for taking the drug and not taking it are not clear in that question. Depending on co-morbidity scoring, with ongoing a fib, it's not a matter of if a stroke happens, it's when. the study subjects would need at least monthly transesophageal echos to be sure they weren't developing left atrial thrombi. How would they even know the appropriate dose to give if it was intermittent? Anyway, lots of questions that there are surely answers to but not available to us.

Just seems like a really risky thing, given the stakes and how safe Xa inhibitors are compared to coumadin or stroke.