title: Novel anticoagulants for stroke prevention in atrial fibrillation: current clinical evidence and future developments.
abstract: Atrial fibrillation (AF) is the most common cardiac rhythm disorder and a major risk factor for ischemic stroke. Antithrombotic therapy using aspirin or vitamin K antagonists (VKA) is currently prescribed for prevention for ischemic stroke in patients with AF. A narrow therapeutic range and the need of regular monitoring of its anticoagulatory effect impair effectiveness and safety of VKA, causing a need for alternative anticoagulant drugs. Recently developed anticoagulants include direct thrombin antagonists such as dabigatran or factor Xa inhibitors such as rivaroxaban, apixaban, betrixaban, and edoxaban. Currently, data from a phase III clinical trial are available for dabigatran only, which show the direct thrombin antagonist to be at least noninferior in efficacy to VKA for the prevention of stroke and systemic embolism in patients with AF. This review focuses on current advances in the development of directly acting oral anticoagulant drugs and their potential to replace the VKA class of drugs in patients with AF.
authors.affiliation: Klinik für Innere Medizin III (Kardiologie, Angiologie und Internistische Intensivmedizin), Universitätsklinikum des Saarlandes, Homburg/Saar, Germany. Stephan.Schirmer@uks.eu
authors.forename: Stephan H
authors.initials: SH
authors.lastname: Schirmer
authors.forename: Magnus
authors.initials: M
authors.lastname: Baumhäkel
authors.forename: Hans-Ruprecht
authors.initials: HR
authors.lastname: Neuberger
authors.forename: Stefan H
authors.initials: SH
authors.lastname: Hohnloser
authors.forename: Isabelle C
authors.initials: IC
authors.lastname: van Gelder
authors.forename: Gregory Y H
authors.initials: GY
authors.lastname: Lip
authors.forename: Michael
authors.initials: M
authors.lastname: Böhm
mesh_terms: D000284:Administration, Oral; D000925:Anticoagulants / Q000494:pharmacology / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000150:complications*; D017326:Clinical Trials, Phase III as Topic; D015507:Drugs, Investigational; D065427:Factor Xa Inhibitors; D006801:Humans; D020521:Stroke / Q000209:etiology / Q000517:prevention & control*; D013917:Thrombin / Q000502:physiology
chemical_list: D000925:Anticoagulants; D015507:Drugs, Investigational; D065427:Factor Xa Inhibitors; D013917:Thrombin