Journal
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY
Volume 56, Issue 25, Pages 2067-2076Publisher
ELSEVIER SCIENCE INC
DOI: 10.1016/j.jacc.2010.09.017
Keywords
anticoagulants; atrial fibrillation; thrombin inhibitor
Categories
Funding
- Deutsche Forschungsgemeinschaft [KFO 196]
- Wissenschaftsministerium des Saarlandes (Klinische Studiengruppe)
- Boehringer Ingelheim
- Sanofi-Aventis
- Cardiome
- ARYx
- Bristol-Myers Squibb
- MSD
- St. Jude Medical
- Medtronic
- Biotronik
- Boehringer
- Pfizer/Bristol-Myers Squibb
- Sanofi
- Astellas
- Merck
- Portola
- Biotronic
- Daiichi-Sankyo
- AstraZeneca
- Pfizer
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Atrial fibrillation (AF) is the most common cardiac rhythm disorder and a major risk factor for ischemic stroke. Antithrombotic therapy using aspirin or vitamin K antagonists (VKA) is currently prescribed for prevention for ischemic stroke in patients with AF. A narrow therapeutic range and the need of regular monitoring of its anticoagulatory effect impair effectiveness and safety of VKA, causing a need for alternative anticoagulant drugs. Recently developed anticoagulants include direct thrombin antagonists such as dabigatran or factor Xa inhibitors such as rivaroxaban, apixaban, betrixaban, and edoxaban. Currently, data from a phase III clinical trial are available for dabigatran only, which show the direct thrombin antagonist to be at least noninferior in efficacy to VKA for the prevention of stroke and systemic embolism in patients with AF. This review focuses on current advances in the development of directly acting oral anticoagulant drugs and their potential to replace the VKA class of drugs in patients with AF. (J Am Coll Cardiol 2010;56:2067-76) (C) 2010 by the American College of Cardiology Foundation
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