title: Promise of factor Xa inhibition in atrial fibrillation.
abstract: Randomized clinical trials have conclusively demonstrated that warfarin prevents stroke in patients with atrial fibrillation. This evidence led the American College of Cardiology, the American Heart Association, and the European Society of Cardiology to designate warfarin as a Class I indication in patients at moderate to high risk for stroke. Despite the evidence from randomized clinical trials and clear practice guidelines, warfarin is underutilized in many eligible patients. This is, at least in part, due to the many challenges associated with warfarin use that have led to the development of many new anticoagulants including direct thrombin inhibitors and factor Xa inhibitors. In this article, we review the complexities of anticoagulation in patients with atrial fibrillation, underscoring the challenges related to warfarin use, and present an overview of new anticoagulants particularly, factor Xa inhibitors, with special emphasis on emerging data from randomized clinical trials on their efficacy and safety in the management of atrial fibrillation.
authors: Division of Cardiology, Department of Medicine, Duke Clinical Research Institute and Duke University, 2400 Pratt Street, PO Box 17969, Durham, NC 27705, USA. alkha001@mc.duke.edu
authors: Sana M
authors: SM
authors: Al-Khatib
authors: John H
authors: JH
authors: Alexander
authors: Renato D
authors: RD
authors: Lopes
authors: Kenneth W
authors: KW
authors: Mahaffey
authors: Manesh R
authors: MR
authors: Patel
authors: Christopher B
authors: CB
authors: Granger
mesh_terms: D000367:Age Factors; D000368:Aged; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology; D001562:Benzimidazoles / Q000627:therapeutic use*; D000069604:Dabigatran; D065427:Factor Xa Inhibitors; D005260:Female; D006801:Humans; D008297:Male; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D020521:Stroke / Q000188:drug therapy* / Q000517:prevention & control; D014481:United States / Q000453:epidemiology; D014859:Warfarin / Q000009:adverse effects / Q000627:therapeutic use*; D015091:beta-Alanine / Q000031:analogs & derivatives* / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D001562:Benzimidazoles; D065427:Factor Xa Inhibitors; D015091:beta-Alanine; D014859:Warfarin; D000069604:Dabigatran