title: Direct oral anticoagulants in atrial fibrillation.
abstract: Atrial fibrillation (AF), the most frequent sustained arrhythmia, is associated with an increased risk of thromboembolic events. The risk of stroke depends on risk factors such as age, hypertension, heart failure, and vascular disease. Thus, antithrombotic therapy is a cornerstone in the management of AF. Warfarin is successfully used to reduce thromboembolic events. More recently, direct thrombin (dabigatran) and factor Xa (apixaban, edoxaban, rivaroxaban) inhibitors have been compared to warfarin in large randomized trials. All new substances have been shown to be non-inferior to warfarin concerning thromboembolic events. Severe bleeding, such as fatal and intracranial bleeding, was less frequent with direct oral anticoagulants. Results of the studies and subgroup analyses are discussed. Further trials using direct oral anticoagulants in special populations such as very old and patients with kidney disease are needed.
authors.affiliation: Heart Clinic Hirslanden Zurich, Zurich, Switzerland. Electronic address: georg.noll@hirslanden.ch.
authors.forename: Georg
authors.initials: G
authors.lastname: Noll
authors.affiliation: University of Zurich, Zurich, Switzerland.
authors.forename: Sarah
authors.initials: S
authors.lastname: Noll
authors.affiliation: Heart Clinic Hirslanden Zurich, Zurich, Switzerland.
authors.forename: David
authors.initials: D
authors.lastname: Hürlimann
mesh_terms: D000284:Administration, Oral; D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects; D001281:Atrial Fibrillation / Q000188:drug therapy* / Q000453:epidemiology; D001562:Benzimidazoles / Q000008:administration & dosage / Q000009:adverse effects; D000069604:Dabigatran; D004617:Embolism / Q000209:etiology; D006470:Hemorrhage / Q000209:etiology; D006801:Humans; D009025:Morpholines / Q000008:administration & dosage / Q000009:adverse effects; D011720:Pyrazoles / Q000008:administration & dosage / Q000009:adverse effects; D011725:Pyridines / Q000008:administration & dosage / Q000009:adverse effects; D011728:Pyridones / Q000008:administration & dosage / Q000009:adverse effects; D012307:Risk Factors; D000069552:Rivaroxaban; D020521:Stroke / Q000209:etiology; D013844:Thiazoles / Q000008:administration & dosage / Q000009:adverse effects; D013876:Thiophenes / Q000008:administration & dosage / Q000009:adverse effects; D014859:Warfarin / Q000008:administration & dosage / Q000009:adverse effects; D015091:beta-Alanine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives
chemical_list: D000925:Anticoagulants; D001562:Benzimidazoles; D009025:Morpholines; D011720:Pyrazoles; D011725:Pyridines; D011728:Pyridones; D013844:Thiazoles; D013876:Thiophenes; D015091:beta-Alanine; C522181:apixaban; D014859:Warfarin; D000069552:Rivaroxaban; D000069604:Dabigatran; C552171:edoxaban