Novel anticoagulants for stroke prevention in patients with atrial fibrillation.
Atrial fibrillation (AF) is the most common cardiac arrhythmia that can potentially result in stroke. Vitamin K antagonists (VKA) like warfarin were for many decades the only oral anticoagulants available for stroke prevention in patients with non-valvular atrial fibrillation (AF) at high risk of stroke. Recently, new oral anticoagulants (NOACS) have been introduced that act via direct inhibition of thrombin (dabigatran) or activated factor X (edoxaban, rivaroxaban and apixaban). Unlike VKAs, these anticoagulants do not require routine INR monitoring and posses favorable pharmacological properties. NOACs act rapidly, and have a stable and predictable dose-related anticoagulant effect with few clinically relevant drug-drug interactions. Phase III trials comparing these agents to warfarin for stroke prevention in patients with non-valvular AF demonstrated that they are at least as efficacious and safe as warfarin. Evolution of clinical guidelines to incorporate the new anticoagulants for stroke prevention in non-valvular AF may result in a reduction in the incidence of AF-related strokes. Safe and effective use of these new drugs in clinical practice requires understanding of their distinct pharmacological properties.
Mount Sinai Medical Center, New York, NY, USA.
A
A
Jalota
T M
TM
Scarabelli
L
L
Saravolatz
M U
MU
Bakhsh
P
P
Agrawal
R
R
Jalota
C
C
Chen-Scarabelli
V
V
Fuster
J
J
Halperin
D000925:Anticoagulants / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D000991:Antithrombins / Q000009:adverse effects / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D016903:Drug Monitoring / Q000379:methods; D065427:Factor Xa Inhibitors / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D019934:International Normalized Ratio; D017410:Practice Guidelines as Topic; D020521:Stroke / Q000209:etiology / Q000517:prevention & control*; D014859:Warfarin / Q000009:adverse effects / Q000627:therapeutic use
D000925:Anticoagulants; D000991:Antithrombins; D065427:Factor Xa Inhibitors; D014859:Warfarin