Document Detail

New options for stroke prevention in atrial fibrillation.
MedLine Citation:
PMID:  21517644     Owner:  NLM     Status:  In-Process    
Randomized trials have demonstrated that warfarin is effective for stroke prevention in patients with atrial fibrillation (AF), yielding relative risk reductions for ischemic stroke of nearly 70%. However, successful use of warfarin requires frequent monitoring and dose adjustment to maintain an international normalized ratio (INR) within the range of 2.0 to 3.0. Many clinicians and patients have been reluctant to use warfarin therapy in AF, with underuse generally attributed to the inconvenience of INR monitoring, complexities of drug and dietary interactions associated with warfarin, and perceived bleeding risk. The ensuing search for safe, effective alternatives with a lower associated risk of bleeding and no need for monitoring and dose adjustment has focused attention on more specific inhibitors of the clotting cascade, such as factor Xa inhibitors or direct thrombin inhibitors. The direct thrombin inhibitor dabigatran has recently been approved by the US Food and Drug Administration for the prevention of stroke in patients with AF. New factor Xa inhibitors apixaban, rivaroxaban, and edoxaban are also currently being studied in stroke prevention trials in patients with AF to determine their comparability with warfarin. It is anticipated that fixed-dose administration of these new oral agents will provide effective anticoagulation without the need for frequent monitoring and with a lower risk of bleeding events.
Christopher P Cannon; Eric C Stecker
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  The American journal of managed care     Volume:  16     ISSN:  1936-2692     ISO Abbreviation:  Am J Manag Care     Publication Date:  2010 Nov 
Date Detail:
Created Date:  2011-04-26     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9613960     Medline TA:  Am J Manag Care     Country:  United States    
Other Details:
Languages:  eng     Pagination:  S291-7     Citation Subset:  H    
Harvard Medical School, Harvard University, Division of Cardiology and Brigham and Women's Hospital, Boston, MA, USA.
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