Trials of Novel Oral Anticoagulants for Stroke Prevention In Patients with Non-valvular Atrial Fibrillation
Jonathan L. Halperin and Paul Dorian
Affiliation: Cardiovascular Institute, Mount Sinai Medical Center, Fifth Avenue at 100th Street, New York, NY 10029-6574, USA.
Keywords: Anticoagulation, antithrombotic therapy, atrial fibrillation, factor IIa inhibitors, factor Xa inhibitors, stroke,
Patients with non-valvular atrial fibrillation (AF) face an increased risk of stroke compared with those in normal
sinus rhythm. The vitamin K antagonist warfarin, available for over half a century, is highly effective in reducing the
risk of stroke in patients with AF, but it is a difficult drug to use properly. As a result, it is challenging to keep the anticoagulant
effect of warfarin in the desired range. Newer oral anticoagulants (NOACs) that directly inhibit Factor IIa (thrombin)
or Factor Xa provide reliable anticoagulation when administer in fixed oral doses without routine coagulation monitoring.
This manuscript will review in detail the pivotal trials of these NOACs that led to their approval as well as comment
on the factors that should influence their selection.
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