title: Novel oral anticoagulants: focus on stroke prevention and treatment of venous thrombo-embolism.
abstract: Anticoagulation for the long-term treatment and prevention of thrombo-embolic diseases as well as for stroke prevention in atrial fibrillation (AF) has been accomplished by vitamin K antagonists for the last half century. Although effective under optimal conditions, the imminent risk of a recurrent event vs. the risk of bleeding due to the narrow therapeutic window, numerous food- and drug interactions, and the need for regular monitoring complicate the long-term use of these drugs and render treatment with these agents complicated. As a result, novel anticoagulants which selectively block key factors in the coagulation cascade are being developed. The efficacy and safety of the direct thrombin inhibitor dabigatran etexilate, as well as of the selective factor Xa inhibitors rivaroxaban and apixaban, have been demonstrated in Phase III trials for stroke prevention in AF and the treatment and secondary prophylaxis of venous thrombo-embolism. This review summarizes the results from recently published pivotal clinical trials and discusses the opportunities as well as uncertainties in the clinical applications of these novel agents.
authors.affiliation: Department of Cardiology, CardioVascular Center, University Hospital Zurich, and Cardiovascular Research, Institute of Physiology, University of Zurich, Rämistrasse 100, CH-8091 Zurich, Switzerland. steffel@access.uzh.ch
authors.forename: Jan
authors.initials: J
authors.lastname: Steffel
authors.forename: Eugene
authors.initials: E
authors.lastname: Braunwald
mesh_terms: D054058:Acute Coronary Syndrome / Q000191:economics / Q000517:prevention & control; D000284:Administration, Oral; D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects / Q000191:economics; D001281:Atrial Fibrillation / Q000188:drug therapy / Q000191:economics; D001562:Benzimidazoles / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D000069604:Dabigatran; D017277:Drug Approval; D005170:Factor X / Q000037:antagonists & inhibitors; D006801:Humans; D009025:Morpholines / Q000627:therapeutic use; D056687:Off-Label Use; D011720:Pyrazoles / Q000627:therapeutic use; D011725:Pyridines / Q000627:therapeutic use; D011728:Pyridones / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D000069552:Rivaroxaban; D020521:Stroke / Q000191:economics / Q000517:prevention & control*; D013876:Thiophenes / Q000627:therapeutic use; D054556:Venous Thromboembolism / Q000188:drug therapy* / Q000191:economics
chemical_list: D000925:Anticoagulants; D001562:Benzimidazoles; D009025:Morpholines; D011720:Pyrazoles; D011725:Pyridines; D011728:Pyridones; D013876:Thiophenes; C522181:apixaban; D005170:Factor X; D000069552:Rivaroxaban; D000069604:Dabigatran