Changing anticoagulant paradigms for atrial fibrillation: dabigatran, apixaban and rivaroxaban.
BACKGROUND
Vitamin K antagonists (VKAs) are the main therapeutic agents used to prevent embolic events in patients with atrial fibrillation (AF). Despite their proven efficacy, VKAs are underused and have several limitations. In recent years, there has been great interest in the development of new oral anticoagulants with a more efficient pharmacological profile, first tested in venous thromboembolism prevention and later in AF.


METHODS
The authors review the pharmacological differences between dabigatran, rivaroxaban and apixaban, and potential subgroups of patients in whom these new drugs would constitute a possible alternative to VKA therapy. Pharmacodynamic and pharmacokinetic data from each compound are analyzed in respect to their potential use in AF. This article provides an exhaustive review of the current status of this topic and the controversies still regarding each drug.


CONCLUSIONS
Apixaban and rivaroxaban are under evaluation for thromboembolic prevention in AF; dabigatran was recently approved for this indication. Therefore, it is important to know the characteristics of these drugs as a potential alternative to VKAs.
Department of Cardiology and Cardiovascular Surgery, FLENI, Montañeses 2325 (1428), Buenos Aires, Argentina. marianoagiorgi@hotmail.com
Mariano A
MA
Giorgi
Hernán
H
Cohen Arazi
Claudio D
CD
Gonzalez
Guillermo
G
Di Girolamo
D000925:Anticoagulants / Q000493:pharmacokinetics / Q000494:pharmacology*; D001281:Atrial Fibrillation / Q000150:complications / Q000188:drug therapy*; D001562:Benzimidazoles / Q000493:pharmacokinetics / Q000494:pharmacology; D000069604:Dabigatran; D015195:Drug Design; D006801:Humans; D009025:Morpholines / Q000493:pharmacokinetics / Q000494:pharmacology; D011720:Pyrazoles / Q000493:pharmacokinetics / Q000494:pharmacology; D011728:Pyridones / Q000493:pharmacokinetics / Q000494:pharmacology; D000069552:Rivaroxaban; D013876:Thiophenes / Q000493:pharmacokinetics / Q000494:pharmacology; D013923:Thromboembolism / Q000209:etiology / Q000517:prevention & control*; D014812:Vitamin K / Q000037:antagonists & inhibitors; D015091:beta-Alanine / Q000031:analogs & derivatives / Q000493:pharmacokinetics / Q000494:pharmacology
D000925:Anticoagulants; D001562:Benzimidazoles; D009025:Morpholines; D011720:Pyrazoles; D011728:Pyridones; D013876:Thiophenes; D015091:beta-Alanine; D014812:Vitamin K; C522181:apixaban; D000069552:Rivaroxaban; D000069604:Dabigatran