Advancement in antithrombotics for stroke prevention in atrial fibrillation.

Journal of Interventional Cardiac Electrophysiology : an International Journal of Arrhythmias and Pacing
Mohammed Haris Umer UsmanMichael Ezekowitz

Abstract

The focus of this review is the evolving field of antithrombotic drug therapy for stroke prevention in patients with atrial fibrillation (AF). The current standard of therapy includes warfarin, acenocoumarol and phenprocoumon which have proven efficacy by reducing stroke by 68% against placebo. However, a narrow therapeutic index, wide variation in metabolism, and numerous food and drug interactions have limited their clinical application to only 50% of the indicated population. Newer agents such as direct thrombin inhibitors, factor Xa inhibitors, factor IX inhibitors, tissue factor inhibitors and a novel vitamin K antagonist are being developed to overcome the limitations of current agents. The direct thrombin inhibitor dabigatran is farthest along in development. Further clinical trial testing, and eventual incorporation into clinical practice will depend on safety, efficacy and cost. Development of a novel vitamin K antagonist with better INR control will challenge the newer mechanistic agents in their quest to replace the existing vitamin K antagonists. Till then, the large unfilled gap to replace conventional agents remains open. This review will assess all these agents, and compare their mechanism of action, stage of dev...Continue Reading

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Citations

Sep 29, 2011·Pharmacotherapy·Estella M DavisJennifer A Campbell
Jun 24, 2015·Journal of Gastroenterology and Hepatology·Yosuke ToyaTakayuki Matsumoto
May 10, 2019·Journal of Anesthesia·Takeshi OmaeYosuke Katsuda
Jun 15, 2011·Circulation Journal : Official Journal of the Japanese Circulation Society·Satoshi OgawaTakeshi Yamashita

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