The Role of Oral Direct Thrombin Inhibitors in Atrial Fibrillation

Atrial fibrillation is a common rhythm disturbance; its most significant adverse events are ischemic stroke and systemic arterial occlusion. Oral anticoagulation with warfarin is an effective therapy for stroke prevention but remains underused due to numerous complications and barriers. Ximelagatran, an oral direct thrombin inhibitor, may become an alternative strategy for clinicians. This agent was developed to overcome many of the limitations associated with warfarin. Its consistent antithrombotic effect and wide therapeutic index allow fixed dosing without the need for routine coagulation monitoring, and without concerns related to drug, food, and disease state interactions. Ximelagatran has been investigated in patients with atrial fibrillation and has been as effective as warfarin for stroke prevention.