Document Detail

Role of new drugs for management of atrial fibrillation.
MedLine Citation:
PMID:  23249869     Owner:  NLM     Status:  In-Data-Review    
OBJECTIVE: To evaluate the role of newer agents in the management of atrial fibrillation (AF).
DATA SOURCES: EMBASE and MEDLINE were searched (up to June 2012) combining medication names with atrial fibrillation, humans, clinical trials, and pharmacoeconomic. References of the articles identified and were also reviewed.
STUDY SELECTION AND DATA EXTRACTION: Studies were limited to the English language with clinical or pharmacoeconomic end points followed by the consensus of 3 authors.
DATA SYNTHESIS: Formulated to reduce some of the adverse effects associated with amiodarone by removing the iodine component, dronedarone has improved clinical outcomes over placebo when used in paroxysmal or persistent AF; however, it is less efficacious than amiodarone. Worse outcomes with dronedarone have been seen in patients with heart failure or permanent AF. It has not been compared to antiarrhythmic agents other than amiodarone, and pharmacoeconomic evaluations are lacking. Dabigatran 150 mg is superior to warfarin in preventing stroke or systemic embolism and has been associated with lower rates of vascular-associated mortality. Although the rates of major bleeding were not significantly different between the 2 agents, gastrointestinal bleeding and myocardial infarction occurred more frequently with dabigatran. Dabigatran appears to have the most pharmacoeconomic benefit over warfarin in patients with a higher risk of stroke. Rivaroxaban is noninferior to warfarin for the prevention of stroke and systemic embolism, with no difference in the rates of major bleeding. Cost-effectiveness studies have not been performed with this agent at this time. In patients with AF who were not suitable candidates for warfarin, apixaban is superior to aspirin in preventing stroke or systemic embolism without increasing the risk for major bleeding. Additionally, apixaban is superior to warfarin in preventing stroke or systemic embolism, results in fewer bleeding events, and is associated with lower mortality. Apixaban is not cost-effective against aspirin when used for a short duration but gains superiority with prolonged use or in patients with higher risks of stroke. Additionally, apixaban appears to offer a pharmacoeconomic advantage over warfarin at no to minimal cost. Each new anticoagulant lacks a reversal agent and an assay to detect the presence of the anticoagulant, as well as long-term data when used in the clinical setting.
CONCLUSIONS: Use of dronedarone should be limited to patients with paroxysmal or persistent AF and should not be used in patients with heart failure or with permanent AF. Newer antithrombotic agents appear to be promising alternatives for the prevention of stroke in patients with AF; however, more data are needed to understand their role.
James M Hollands; Mollie Gowan; Jennifer N Riney; Eli N Deal; Andrew M Kates
Related Documents :
8222769 - Cerebrospinal fluid ferritin in patients with meningitis and cerebral infarction or ble...
1541099 - Evaluation of hypoxic brain injury with spinal fluid enzymes, lactate, and pyruvate.
22973339 - Relationship between echocardiographic findings and laboratory serum biomarkers in pati...
9818869 - Csf and mri findings in patients with acute herpes zoster.
25052699 - Which method of left atrium size quantification is the most accurate to recognize throm...
24527429 - Left atrial thrombosis in an anticoagulated patient after bioprosthetic valve replaceme...
25111719 - Endoscopic management for patients with serrated polyposis syndrome is feasible and eff...
17895549 - Enhanced expression of myeloid-related protein complex (mrp8/14) in macrophages and mul...
25344769 - Coronary artery disease as an independent predictor of survival in patients with type 2...
Publication Detail:
Type:  Journal Article     Date:  2012-12-18
Journal Detail:
Title:  The Annals of pharmacotherapy     Volume:  46     ISSN:  1542-6270     ISO Abbreviation:  Ann Pharmacother     Publication Date:  2012 Dec 
Date Detail:
Created Date:  2012-12-19     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9203131     Medline TA:  Ann Pharmacother     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1656-70     Citation Subset:  IM    
Cardiac Intensive Care, Department of Pharmacy, Barnes-Jewish Hospital at Washington University Medical Center, St. Louis, MO.
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms

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

Previous Document:  Effects of chemotherapy and psychosocial distress on perceived cognitive disturbances in asian breas...
Next Document:  A review and assessment of drug-induced parotitis.