Document Detail


Antithrombotic therapy for stroke prevention in non-valvular atrial fibrillation.
MedLine Citation:
PMID:  23153406     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
The world faces an epidemic of atrial fibrillation and atrial fibrillation-related stroke. An individual's risk of atrial fibrillation-related stroke can be estimated with the CHADS(2) or CHA(2)DS(2)VASc scores, and reduced by two-thirds with effective anticoagulation. Vitamin K antagonists, such as warfarin, are underused and often poorly managed. The direct thrombin inhibitor dabigatran etexilate and factor Xa inhibitors rivaroxaban and apixaban are new oral anticoagulants that are at least as efficacious and safe as warfarin. Their advantages are predictable anticoagulant effects, low propensity for drug interactions, and lower rates of intracranial haemorrhage than with warfarin. A disadvantage is the continuing need to develop and validate rapidly effective antidotes for major bleeding and standardised tests that accurately measure plasma concentrations and anticoagulant effects, together with the disadvantage of possible higher rates of gastrointestinal haemorrhage and greater expense than with warfarin. The new oral anticoagulants should increase the number of patients with atrial fibrillation at risk of stroke who are optimally anticoagulated, and reduce the burden of atrial fibrillation-related stroke.
Authors:
Mark J Alberts; John W Eikelboom; Graeme J Hankey
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't; Review    
Journal Detail:
Title:  The Lancet. Neurology     Volume:  11     ISSN:  1474-4465     ISO Abbreviation:  Lancet Neurol     Publication Date:  2012 Dec 
Date Detail:
Created Date:  2012-11-16     Completed Date:  2013-01-18     Revised Date:  2014-08-15    
Medline Journal Info:
Nlm Unique ID:  101139309     Medline TA:  Lancet Neurol     Country:  England    
Other Details:
Languages:  eng     Pagination:  1066-81     Citation Subset:  IM    
Copyright Information:
Copyright © 2012 Elsevier Ltd. All rights reserved.
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MeSH Terms
Descriptor/Qualifier:
Administration, Oral
Animals
Anticoagulants / administration & dosage*,  adverse effects
Atrial Fibrillation / drug therapy*,  epidemiology
Clinical Trials as Topic / methods
Fibrinolytic Agents / administration & dosage*,  adverse effects
Heart Valves / physiology
Hemorrhage / chemically induced,  epidemiology,  prevention & control
Humans
Stroke / epidemiology,  prevention & control*
Treatment Outcome
Chemical
Reg. No./Substance:
0/Anticoagulants; 0/Fibrinolytic Agents

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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