New anticoagulants for atrial fibrillation.
Although warfarin and other vitamin K antagonists have clearly the greatest efficacy among treatments commonly available in preventing stroke in atrial fibrillation, their use is associated with a substantial risk of major bleedings and are unpractical and difficult to use because of their narrow therapeutic window, their interaction with drugs and foods, and the need of frequent coagulation monitoring. Several new anticoagulants are now undergoing phase III clinical trials in atrial fibrillation with the aim of demonstrating noninferiority compared with vitamin K antagonists or superiority compared with aspirin in patients in whom vitamin K antagonists are contraindicated or not tolerated. These drugs fall in different pharmacological categories of oral direct thrombin inhibitors, parenteral long-lived indirect factor Xa inhibitors, and oral direct factor Xa inhibitors. Cardiologists need to be aware of the explosive pharmacological literature being accrued with these new drugs, as most of these will likely enter the clinical arena in the near future.
Institute of Cardiology and Center of Excellence on Aging, 'G. d'Annunzio' University - Chieti, Italy. rdecater@unich.it
Raffaele
R
De Caterina
Steen Dalby
SD
Kristensen
Giulia
G
Renda
D000284:Administration, Oral; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000150:complications / Q000188:drug therapy*; D003374:Coumarins / Q000627:therapeutic use; D015507:Drugs, Investigational / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D065427:Factor Xa Inhibitors; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D007267:Injections; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D018570:Risk Assessment; D020521:Stroke / Q000209:etiology / Q000517:prevention & control*; D013917:Thrombin / Q000037:antagonists & inhibitors; D013927:Thrombosis / Q000209:etiology / Q000517:prevention & control*; D016896:Treatment Outcome; D014812:Vitamin K / Q000037:antagonists & inhibitors
D000925:Anticoagulants; D003374:Coumarins; D015507:Drugs, Investigational; D065427:Factor Xa Inhibitors; D005343:Fibrinolytic Agents; D010975:Platelet Aggregation Inhibitors; D014812:Vitamin K; D013917:Thrombin