Atrial fibrillation (AF), the most common, clinically significant, cardiac arrhythmia affects 1% of the general
population and has important hemodynamic and thromboembolic complications that contribute to elevated morbidity and
mortality. AF increases the overall risk of stroke five-fold, accounting for approximately 15% of all strokes and is
associated with particularly severe stroke. For the last 50 years, long-term anticoagulation with vitamin K antagonists has
been the most effective therapy for preventing stroke and systemic embolism in patients with AF and other risk factors,
but their use has a lot of limitations and drawbacks (frequent monitoring and dose adjustment, food and drug interactions,
delayed onset of action etc). Nowadays, new oral anticoagulants have emerged that seem to overcome those limitations.
Direct thrombin inhibitor dabigatran and factor Xa inhibitors rivaroxaban and apixaban have proven, in large, multicenter,
randomized, phase III, clinical studies, to be at least as efficient as warfarin in stroke prevention in patients with AF. RELY
and ROCKET AF trials have contributed to market approval of dabigatran and rivaroxaban, respectively and made
them available to clinical practice. Another factor Xa inhibitor, edoxaban, is under evaluation in an ongoing phase III
clinical trial and others such as AZD0837, betrixaban and darexaban are still in safety and tolerability phase II studies.
The oral anticoagulation landscape is changing rapidly and these new agents seem to be very promising. However future
post-marketing studies and registries will help clarify their efficacy and safety.
Keywords: Atrial fibrillation, direct thrombin inhibitors, factor Xa inhibitors, oral anticoagulants, stroke prevention, Dabigatran, Edoxaban, Study Drug, Rivaroxaban, stroke prevention
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