NOAC in Acute Coronary Syndrome and AF?
Maria Niespialowska-Steuden, Peter Collins, Charis Costopoulos and Diana A. Gorog
Affiliation: E&N Hertfordshire NHS Trust, UK.
Keywords: Acute coronary syndrome, atrial fibrillation, direct thrombin inhibitor, factor Xa inhibitor, novel anticoagulants,
vitamin K antagonist.
Cardiovascular disease remains a major cause of morbidity and mortality in developed countries. New treatments,
in the form of novel oral anticoagulants (NOAC) that reduce thrombotic risk are now available for patients with
atrial fibrillation (AF) or acute coronary syndrome (ACS). Warfarin has been the cornerstone of thromboprophylaxis in
patients with AF, but treatment is cumbersome, inconvenient and often unreliable, with fluctuating time in therapeutic
range. Thrombotic events also continue to occur in a significant number of ACS patients despite antiplatelet therapy. Thus
there is an unfilled need to reduce thrombotic events in ACS and AF patients. NOAC comprise direct factor Xa inhibitors
(apixaban, rivaroxaban, darexaban, edoxaban), direct thrombin inhibitors (dabigatran) and PAR-1 antagonists (vorapaxar,
atopaxar). In this review, we compare and contrast NOACs and review their individual and specific clinical trial database
in ACS and AF. In the setting of ACS, the role of NOAC is unclear, as any reduction in ischemic events appears to be offset
by hemorrhagic risk. However, NOAC have a definite place in the treatment of patients with non-valvular AF, where
they are at least as effective, if not superior to warfarin.
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