Key result
New antithrombotics like dabigatran and rivaroxaban are approved for stroke prevention in atrial fibrillation, while terutroban lacked efficacy over aspirin and vorapaxar increased hemorrhage.
This 2011 review highlights the emergence of novel oral anticoagulants for stroke prevention in atrial fibrillation and the failure or safety concerns of newer antiplatelets like terutroban and vorapaxar in secondary stroke prevention.
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Supports NOAC preference in AF stroke prevention; leaves open safer antiplatelet options after secondary prevention setbacks.
Several new antithrombotic drugs have been developed and approved to use in clinical practice recently. Dabigatran, a direct thrombin inhibitor, and rivaroxaban, a factor Xa inhibitor, have been approved in many countries including Korea to prevent stroke in patient with atrial fibrillation. Apixaban, another factor Xa inhibitor, showed good results in clinical trial and is waiting for approval for clinical use. New antiplatelet agent, terutroban, selective thromboxane A2 receptor inhibitor, failed to prove the efficacy over the aspirin in secondary stroke prevention. Vorapaxar, a new antiplatelet agent that inhibits thrombin through PAR-1 antagonism, showed a high incidence of intracranial hemorrhage in patient with a history of stroke.
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Seo et al. (2012) conducted a review in Stroke and atrial fibrillation. New antithrombotics was evaluated. New antithrombotics like dabigatran and rivaroxaban are approved for stroke prevention in atrial fibrillation, while terutroban lacked efficacy over aspirin and vorapaxar increased hemorrhage.
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