Title:Primary Prevention of Ischaemic Stroke in Atrial Fibrillation: New Oral Anticoagulant Drugs for all?
Volume: 12
Issue: 3
Author(s): James Foley, Paulus Kirchhof and Gregory Y. H. Lip
Affiliation:
Keywords:
Apixaban, atrial fibrillation, dabigatran, rivaroxaban, stroke prevention, warfarin.
Abstract: Atrial fibrillation (AF) confers a 4.5% risk of stroke per year. The risk of stroke increases with various risk factors
and until recently, warfarin has been the gold standard of thromboembolism prophylaxis in AF for many years. The
dosage of warfarin requires regular adjustment dependent on the INR, to keep within a narrow therapeutic range of 2.0-
3.0.
The INR can be altered by concomitant drugs, foods and alcohol and requires inconvenient blood monitoring. Underanticoagulation
places patients at risk of stroke, whilst over-anticoagulation confers significant bleeding risk. Consequently
approximately half who would benefit from oral anticoagulation do not have it prescribed.
Novel oral anticoagulants with predictable pharmacokinetics and improved efficacy and safety profiles are currently being
developed for stroke prevention in AF. Three novel oral anticoagulants have just completed Phase III trials for stroke prevention,
all with impressive results; the direct thrombin inhibitor, dabigatran and the oral factor Xa inhibitors, rivaroxaban
and apixaban.
