title: Review of atrial fibrillation outcome trials of oral anticoagulant and antiplatelet agents.
abstract: Atrial fibrillation (AF) is strongly associated with cardioembolic stroke, and thromboprophylaxis is an established means of reducing stroke risk in patients with AF. Oral vitamin K antagonists such as warfarin have been the mainstay of therapy for stroke prevention in patients with AF. However, they are associated with a number of limitations, including excessive bleeding when not adequately controlled. Antiplatelet agents do not match vitamin K antagonists in terms of their preventive efficacy. Dual-antiplatelet therapy (clopidogrel and acetylsalicylic acid) or combined antiplatelet-vitamin K antagonist therapy in AF has also failed to provide convincing evidence of their additional benefit over vitamin K antagonists alone. Novel oral anticoagulants, including the direct thrombin inhibitor dabigatran and direct Factor Xa inhibitors such as rivaroxaban, apixaban, and edoxaban, have now been approved or are currently in late-stage clinical development in AF. These newer agents may provide a breakthrough in the optimal management of stroke risk.
authors.affiliation: Department of Cardiology, University Hospital Jean Minjoz, EA3920, Boulevard Fleming, 25000 Besançon, France. jpbassan@univ-fcomte.fr
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Bassand
mesh_terms: D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use*; D000991:Antithrombins / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000188:drug therapy* / Q000517:prevention & control; D002986:Clinical Trials as Topic; D004359:Drug Therapy, Combination; D065427:Factor Xa Inhibitors; D005260:Female; D006801:Humans; D008297:Male; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D012306:Risk; D020521:Stroke / Q000517:prevention & control; D016896:Treatment Outcome; D014812:Vitamin K / Q000037:antagonists & inhibitors
chemical_list: D000925:Anticoagulants; D000991:Antithrombins; D065427:Factor Xa Inhibitors; D010975:Platelet Aggregation Inhibitors; D014812:Vitamin K