Do novel oral anticoagulants (dabigatran, rivaroxaban, apixaban) improve stroke prevention in AF and treatment of VTE compared to vitamin K antagonists?
This review summarizes Phase III trial evidence demonstrating the efficacy and safety of novel oral anticoagulants (dabigatran, rivaroxaban, apixaban) as alternatives to vitamin K antagonists for AF and VTE.
Anticoagulation for the long-term treatment and prevention of thrombo-embolic diseases as well as for stroke prevention in atrial fibrillation (AF) has been accomplished by vitamin K antagonists for the last half century. Although effective under optimal conditions, the imminent risk of a recurrent event vs. the risk of bleeding due to the narrow therapeutic window, numerous food- and drug interactions, and the need for regular monitoring complicate the long-term use of these drugs and render treatment with these agents complicated. As a result, novel anticoagulants which selectively block key factors in the coagulation cascade are being developed. The efficacy and safety of the direct thrombin inhibitor dabigatran etexilate, as well as of the selective factor Xa inhibitors rivaroxaban and apixaban, have been demonstrated in Phase III trials for stroke prevention in AF and the treatment and secondary prophylaxis of venous thrombo-embolism. This review summarizes the results from recently published pivotal clinical trials and discusses the opportunities as well as uncertainties in the clinical applications of these novel agents.
Steffel et al. (2011) studied this question.