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Novel Anticoagulants for Stroke Prevention in Patients with Atrial Fibrillation

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Abstract

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.

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Authors and Affiliations

  1. Mount Sinai Medical Center, New York, NY, USA

    A. Jalota, T. M. Scarabelli, M. U. Bakhsh, P. Agrawal, V. Fuster & J. Halperin

  2. St John Hospital and Medical Center, Wayne State University School of Medicine, Detroit, MI, USA

    T. M. Scarabelli & L. Saravolatz

  3. King George’s Medical University, Lucknow, UP, India

    R. Jalota

  4. VA Ann Arbor Health Care System, University of Michigan, Ann Arbor, MI, USA

    C. Chen-Scarabelli

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  1. A. Jalota
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Jalota, A., Scarabelli, T.M., Saravolatz, L. et al. Novel Anticoagulants for Stroke Prevention in Patients with Atrial Fibrillation. Cardiovasc Drugs Ther 28, 247–262 (2014). https://doi.org/10.1007/s10557-014-6524-y

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