title: [New oral anticoagulants in nonvalvular atrial fibrillation].
abstract: Vitamin K antagonists (VKA) had several decades of proven efficacy in AF-related stroke prevention but the drug's numerous limitations make its implementation difficult for practitioners and patients. The drawbacks of VKA have prompted the development of new oral anticoagulants (NOAC) that are at least as efficacious and safe as warfarin in phase III trials. Dabigatran (220 and 300mg/day), rivaroxaban (20mg/day) and apixaban (10mg/day) were proved to be non-inferior compared with warfarin in the prevention of bleeding, stroke and systemic embolism. Dabigatran 300mg/day and apixaban were found to be statistically superior to warfarin in stroke reduction. All these drugs reduced the risk of intracranial bleeding compared to warfarin. Dabigatran 220mg/day and apixaban decreased the risk of major bleeding. The limitation of NOAC was an increase of gastrointestinal bleeding by dabigatran 300mg/j and rivaroxaban and myocardial infarction by dabigatran. Practitioners must also be aware of the disadvantages of these new drugs when choosing NOAC for their patients with unstable INR.
authors.affiliation: Centre hospitalier Lyon-Sud, hospices civils de Lyon, Université Claude-Bernard Lyon 1, service de médecine interne et médecine vasculaire, Lyon, France; Université Jean-Monnet, EA3065, groupe de recherche sur la thrombose, 42023 Saint-Étienne, France. Electronic address: jean-christophe.lega@chu-lyon.fr.
authors.forename: Jean-Christophe
authors.initials: JC
authors.lastname: Lega
authors.forename: Laurent
authors.initials: L
authors.lastname: Bertoletti
authors.forename: Stéphane
authors.initials: S
authors.lastname: Durupt
authors.forename: Magali
authors.initials: M
authors.lastname: Epinat
authors.forename: Patrick
authors.initials: P
authors.lastname: Mismetti
authors.forename: Antoine
authors.initials: A
authors.lastname: Da Costa
authors.forename: Silvy
authors.initials: S
authors.lastname: Laporte
mesh_terms: D000284:Administration, Oral; D000925:Anticoagulants / Q000008:administration & dosage*; D001281:Atrial Fibrillation / Q000150:complications*; D001562:Benzimidazoles / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000209:etiology / Q000517:prevention & control; D000069604:Dabigatran; D006801:Humans; D011720:Pyrazoles / Q000627:therapeutic use; D011728:Pyridones / Q000627:therapeutic use; D020521:Stroke; D015091:beta-Alanine / Q000031:analogs & derivatives / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D001562:Benzimidazoles; D011720:Pyrazoles; D011728:Pyridones; D015091:beta-Alanine; C522181:apixaban; D000069604:Dabigatran