Abstract
Patients with atrial fibrillation (AF) face an elevated risk of stroke compared with patients who have normal sinus rhythm. Warfarin, an oral vitamin K antagonist, is a highly effective therapeutic agent to reduce stroke risk in patients with AF; however, use of warfarin is complicated by variable patient dose response due to genetic factors and multiple food-drug and drug-drug interactions. Novel oral anticoagulants appear to be a safe, effective alternative to warfarin therapy without the need for routine coagulation monitoring. Dabigatran, a direct thrombin inhibitor, has been commercially available since 2010 for prevention of stroke in patients with nonvalvular AF. More recently, the US Food and Drug Administration (FDA) approved 2 oral activated factor X inhibitors, rivaroxaban and apixaban, for stroke prevention in patients with AF based on clinical trial evidence of their safety and efficacy. In this article, we provide an overview of the 3 novel oral anticoagulants for treating patients with AF and discuss the latest findings from subgroup analyses.
MeSH terms
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Administration, Oral
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Aging
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Anticoagulants / administration & dosage
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Anticoagulants / adverse effects
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Anticoagulants / therapeutic use
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Antithrombins / therapeutic use
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Atrial Fibrillation / complications
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Atrial Fibrillation / drug therapy*
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Benzimidazoles / administration & dosage
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Benzimidazoles / adverse effects
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Benzimidazoles / therapeutic use*
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Clinical Trials as Topic
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Comorbidity
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Dabigatran
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Hemorrhage / chemically induced
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Humans
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Meta-Analysis as Topic
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Morpholines / administration & dosage
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Morpholines / adverse effects
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Morpholines / therapeutic use*
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Pyrazoles / administration & dosage
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Pyrazoles / adverse effects
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Pyrazoles / therapeutic use*
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Pyridones / administration & dosage
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Pyridones / adverse effects
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Pyridones / therapeutic use*
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Risk Assessment / methods
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Rivaroxaban
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Stroke / drug therapy
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Stroke / etiology
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Stroke / prevention & control*
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Thiophenes / administration & dosage
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Thiophenes / adverse effects
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Thiophenes / therapeutic use*
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Warfarin / administration & dosage
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Warfarin / adverse effects
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Warfarin / therapeutic use*
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beta-Alanine / administration & dosage
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beta-Alanine / adverse effects
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beta-Alanine / analogs & derivatives*
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beta-Alanine / therapeutic use
Substances
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Anticoagulants
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Antithrombins
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Benzimidazoles
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Morpholines
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Pyrazoles
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Pyridones
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Thiophenes
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beta-Alanine
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apixaban
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Warfarin
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Rivaroxaban
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Dabigatran