title: Use of novel oral anticoagulants for patients with atrial fibrillation: systematic review and clinical implications.
abstract: Atrial fibrillation (AF), a common arrhythmia, increases the risk of ischemic stroke. Stroke and bleeding scores for patients with AF can help to stratify risk and determine the need for antithrombotic therapy, for which warfarin has been the gold standard. Although highly effective, warfarin has several limitations that can lead to its underuse. Data from randomized, Phase III clinical trials of the novel oral anticoagulants, dabigatran, a direct thrombin inhibitor, and rivaroxaban and apixaban, both factor Xa inhibitors, indicate these drugs are at least noninferior to warfarin for the prevention of stroke and systemic embolism. They are easier to administer, and have an equivalent or lower risk of bleeding versus warfarin. A better understanding of the risks and benefits of the novel oral anticoagulants, and their use in clinical practice, will prepare clinicians to anticipate and address educational and clinical needs of AF patients and their families, and promote evidence-based prescription of appropriate and safe anticoagulation therapy.
authors.affiliation: Research and Innovation, Cleveland Clinic Health System, USA; George M and Linda H Kaufman Center for Heart Failure, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue J3-4, Cleveland, OH 44195, USA. Electronic address: albertn@ccf.org.
authors.forename: Nancy M
authors.initials: NM
authors.lastname: Albert
mesh_terms: D000284:Administration, Oral; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000188:drug therapy*; D001562:Benzimidazoles / Q000627:therapeutic use; D000069604:Dabigatran; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D009025:Morpholines / Q000627:therapeutic use; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011720:Pyrazoles / Q000627:therapeutic use; D011728:Pyridones / Q000627:therapeutic use; D018570:Risk Assessment; D000069552:Rivaroxaban; D020521:Stroke / Q000517:prevention & control*; D013876:Thiophenes / Q000627:therapeutic use; D014859:Warfarin / Q000009:adverse effects / Q000627:therapeutic use; D015091:beta-Alanine / Q000031:analogs & derivatives / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D001562:Benzimidazoles; D009025:Morpholines; D010975:Platelet Aggregation Inhibitors; D011720:Pyrazoles; D011728:Pyridones; D013876:Thiophenes; D015091:beta-Alanine; C522181:apixaban; D014859:Warfarin; D000069552:Rivaroxaban; D000069604:Dabigatran
keywords: AF; Atrial fibrillation; CHA(2)DS(2)-VASc; CHADS(2); CI; CrCl; Dabigatran; GI; HAS-BLED; ICH; INR; MI; Novel oral anticoagulants; RR; Rivaroxaban; TTR; Warfarin; atrial fibrillation; cardiac failure, hypertension, age, diabetes, stroke (doubled); confidence interval; congestive heart failure, hypertension, age ≥75 years (doubled), diabetes, previous stroke or transient ischemic attack (doubled), vascular disease, sex category; creatinine clearance; gastrointestinal; hypertension, abnormal renal/liver function, stroke, bleeding history or predisposition, labile international normalized ratio, elderly, drugs/alcohol; international normalized ratio; intracranial hemorrhage; myocardial infarction; relative risk; time in therapeutic range