TY - JOUR
T1 - New oral anticoagulants in atrial fibrillation and acute coronary syndromes
T2 - ESC Working Group on Thrombosis-Task Force on Anticoagulants in Heart Disease position paper
AU - De Caterina, Raffaele
AU - Husted, Steen
AU - Wallentin, Lars
AU - Andreotti, Felicita
AU - Arnesen, Harald
AU - Bachmann, Fedor
AU - Baigent, Colin
AU - Huber, Kurt
AU - Jespersen, Jørgen
AU - Kristensen, Steen Dalby
AU - Lip, Gregory Y.H.
AU - Morais, João
AU - Rasmussen, Lars Hvilsted
AU - Siegbahn, Agneta
AU - Verheugt, Freek W A
AU - Weitz, Jeffrey I
AU - Coordinating Committee
N1 - Copyright © 2012 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
PY - 2012
Y1 - 2012
N2 - Until recently, vitamin K antagonists were the only available oral anticoagulants, but with numerous limitations that prompted the introduction of new oral anticoagulants targeting the single coagulation enzymes thrombin (dabigatran) or factor Xa (apixaban, rivaroxaban, and edoxaban) and given in fixed doses without coagulation monitoring. Here we review the pharmacology and the results of clinical trials with these new agents in stroke prevention in atrial fibrillation and secondary prevention after acute coronary syndromes, providing perspectives on their future incorporation into clinical practice. In phase III trials in atrial fibrillation, compared with warfarin, dabigatran etexilate 150 mg B.I.D. reduced the rates of stroke/systemic embolism without any difference in major bleeding; dabigatran etexilate 110 mg B.I.D. had similar efficacy with decreased bleeding; apixaban 5 mg B.I.D. reduced stroke, systemic embolism, and mortality as well as major bleeding; and rivaroxaban 20 mg Q.D. was noninferior to warfarin for stroke and systemic embolism without a difference in major bleeding. All these agents reduced intracranial hemorrhage. Edoxaban is currently being evaluated in a further large phase III trial. Apixaban and rivaroxaban were evaluated in phase III trials for prevention of recurrent ischemia in patients with acute coronary syndromes who were mostly receiving dual antiplatelet therapy, with conflicting results on efficacy but consistent results for increased major bleeding. Overall, the new oral anticoagulants are poised to replace vitamin K antagonists for many patients with atrial fibrillation and may have a role after acute coronary syndromes. Although convenient to administer and manage, they present challenges that need to be addressed.
AB - Until recently, vitamin K antagonists were the only available oral anticoagulants, but with numerous limitations that prompted the introduction of new oral anticoagulants targeting the single coagulation enzymes thrombin (dabigatran) or factor Xa (apixaban, rivaroxaban, and edoxaban) and given in fixed doses without coagulation monitoring. Here we review the pharmacology and the results of clinical trials with these new agents in stroke prevention in atrial fibrillation and secondary prevention after acute coronary syndromes, providing perspectives on their future incorporation into clinical practice. In phase III trials in atrial fibrillation, compared with warfarin, dabigatran etexilate 150 mg B.I.D. reduced the rates of stroke/systemic embolism without any difference in major bleeding; dabigatran etexilate 110 mg B.I.D. had similar efficacy with decreased bleeding; apixaban 5 mg B.I.D. reduced stroke, systemic embolism, and mortality as well as major bleeding; and rivaroxaban 20 mg Q.D. was noninferior to warfarin for stroke and systemic embolism without a difference in major bleeding. All these agents reduced intracranial hemorrhage. Edoxaban is currently being evaluated in a further large phase III trial. Apixaban and rivaroxaban were evaluated in phase III trials for prevention of recurrent ischemia in patients with acute coronary syndromes who were mostly receiving dual antiplatelet therapy, with conflicting results on efficacy but consistent results for increased major bleeding. Overall, the new oral anticoagulants are poised to replace vitamin K antagonists for many patients with atrial fibrillation and may have a role after acute coronary syndromes. Although convenient to administer and manage, they present challenges that need to be addressed.
KW - Acute Coronary Syndrome
KW - Administration, Oral
KW - Advisory Committees
KW - Anticoagulants
KW - Atrial Fibrillation
KW - Heart Diseases
KW - Humans
KW - Periodicals as Topic
KW - Societies, Medical
KW - Thrombosis
U2 - 10.1016/j.jacc.2012.02.008
DO - 10.1016/j.jacc.2012.02.008
M3 - Journal article
C2 - 22497820
SN - 0735-1097
VL - 59
SP - 1413
EP - 1425
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 16
ER -