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. 2013 Oct 31;6(1):46.
doi: 10.1186/1755-7682-6-46.

A new era of stroke prevention in atrial fibrillation: comparing a new generation of oral anticoagulants with warfarin

Bruce S Stambler  1
Affiliations

A new era of stroke prevention in atrial fibrillation: comparing a new generation of oral anticoagulants with warfarin

Bruce S Stambler. Int Arch Med. .

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.

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Figures

Figure 1
Figure 1
Anticoagulant sites of action within the coagulation cascade. Warfarin inhibits production of factors IIa, VIIa, IXa, and Xa, whereas the novel oral anticoagulants directly inhibit either the thrombin (factor IIa) molecule or factor Xa. aPTT, activated partial thromboplastin time; PT, prothrombin time.
See this image and copyright information in PMC

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