A New Era of Stroke Prevention in Atrial Fibrillation: Comparing a New Generation of Oral Anticoagulants with Warfarin

Overview

Journal Int Arch Med

Publisher iMedPub

Specialty General Medicine

Date 2013 Nov 1

PMID 24171796

Citations 5

Authors

Bruce S Stambler

Affiliations

Soon will be listed here.

Abstract

Traditionally, warfarin has been used to prevent stroke in patients with atrial fibrillation (AF), but data from large, multinational, prospective, randomized studies suggest that novel oral anticoagulants (NOACs) may be suitable alternatives. These include the direct thrombin inhibitor dabigatran and the factor Xa inhibitors rivaroxaban, apixaban, and edoxaban. These data showed that dabigatran 150 mg twice daily was more effective at preventing stroke than warfarin, with similar rates of major bleeding, while rivaroxaban 20 mg once daily was noninferior to warfarin, with no difference in major bleeding rates. In addition, apixaban 5 mg twice daily was shown to be superior to warfarin for preventing stroke, with lower bleeding rates. Currently, edoxaban is still in clinical trials. NOACs offer more predictable anticoagulant effects than warfarin and do not require regular monitoring; however, different NOACs are associated with varied drug interactions and limitations related to use in certain patient populations. Overall, the clinical data suggest that these novel agents will offer new options for stroke prevention in patients with AF.

Citing Articles

Safety and Interactions of Direct Oral Anticoagulants with Antiarrhythmic Drugs.

Celikyurt I, Meier C, Kuhne M, Schaer B Drug Saf. 2017; 40(11):1091-1098.

PMID: 28689334 DOI: 10.1007/s40264-017-0567-5.

The Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF) : Exploring the changes in anticoagulant practice in patients with non-valvular atrial fibrillation in the Netherlands.

Ten Cate V, ten Cate H, Verheugt F Neth Heart J. 2016; 24(10):574-80.

PMID: 27561277 PMC: 5039131. DOI: 10.1007/s12471-016-0874-y.

Edoxaban.

Cada D, Baker D, Ingram K Hosp Pharm. 2015; 50(7):619-34.

PMID: 26445907 PMC: 4589853. DOI: 10.1310/hpj5007-619.

Genetic risk for atrial fibrillation could motivate patient adherence to warfarin therapy: a cost effectiveness analysis.

Shiffman D, Perez M, Bare L, Louie J, Arellano A, Devlin J BMC Cardiovasc Disord. 2015; 15:104.

PMID: 26419225 PMC: 4587718. DOI: 10.1186/s12872-015-0100-7.

Edoxaban: an update on the new oral direct factor Xa inhibitor.

Bounameaux H, Camm A Drugs. 2014; 74(11):1209-31.

PMID: 25034361 PMC: 4107274. DOI: 10.1007/s40265-014-0261-1.

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