Document Detail

Stroke prevention in atrial fibrillation: do we still need warfarin?
MedLine Citation:
PMID:  22143201     Owner:  NLM     Status:  MEDLINE    
PURPOSE OF REVIEW: Oral anticoagulation with vitamin K antagonists (warfarin, phenprocoumon) is successful in both primary and secondary stroke prevention in patients with atrial fibrillation, yielding a 60-70% relative reduction in stroke risk compared with placebo, as well as a mortality reduction of 26%. However, these agents have a number of well documented shortcomings. Acetylsalicylic acid (ASA) reduces the relative risk of stroke by a nonsignificant 19% compared with placebo, and increased bleeding risk offsets any therapeutic gain from the combination of ASA with clopidogrel. This review describes the current landscape and developments in stroke prevention in patients with atrial fibrillation, with special reference to secondary prevention.
RECENT FINDINGS: A number of new drugs for oral anticoagulation that do not exhibit the limitations of vitamin K antagonists are under investigation. These include direct factor Xa inhibitors and direct thrombin inhibitors. Recent studies (RE-LY, ROCKET-AF, AVERROES, ARISTOTLE) provide promising results for new agents, including higher efficacy and significantly lower incidences of intracranial bleeds compared with warfarin. The new substances show similar results in secondary as in primary stroke prevention in patients with atrial fibrillation.
SUMMARY: New anticoagulants add to the therapeutic options for patients with atrial fibrillation, and offer a number of advantages over warfarin, for both the clinician and patient, including a favourable bleeding profile and convenience of use. Consideration of these new anticoagulants will improve clinical decision making.
Hans-Christoph Diener; Ralph Weber; Gregory Y H Lip; Stefan H Hohnloser
Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't; Review    
Journal Detail:
Title:  Current opinion in neurology     Volume:  25     ISSN:  1473-6551     ISO Abbreviation:  Curr. Opin. Neurol.     Publication Date:  2012 Feb 
Date Detail:
Created Date:  2012-01-06     Completed Date:  2012-04-23     Revised Date:  2013-01-18    
Medline Journal Info:
Nlm Unique ID:  9319162     Medline TA:  Curr Opin Neurol     Country:  England    
Other Details:
Languages:  eng     Pagination:  27-35     Citation Subset:  IM    
Department of Neurology and Stroke Center, University Hospital Essen, University of Duisburg-Essen, Germany.
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MeSH Terms
Anticoagulants / therapeutic use*
Atrial Fibrillation / complications*,  drug therapy*
Benzimidazoles / therapeutic use
Clinical Trials as Topic
Decision Making
Factor Xa / antagonists & inhibitors
Risk Factors
Stroke / etiology*,  prevention & control*
Thrombin / antagonists & inhibitors
Vitamin K / antagonists & inhibitors
Warfarin / therapeutic use*
beta-Alanine / analogs & derivatives,  therapeutic use
Reg. No./Substance:
0/Anticoagulants; 0/Benzimidazoles; 107-95-9/beta-Alanine; 12001-79-5/Vitamin K; 81-81-2/Warfarin; EC; EC Xa; I0VM4M70GC/dabigatran

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

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