Oral anticoagulation therapy decreases the incidence of cardioembolic stroke in patients with atrial fibrillation by more than 50%, with new direct oral anticoagulants aiming to overcome VKA limitations.
Do new direct oral anticoagulants prevent embolic events and improve safety, efficacy, and quality of life compared to vitamin K antagonists in patients with nonvalvular atrial fibrillation?
This review summarizes the pharmacokinetics, safety, efficacy, quality of life, and cost-effectiveness of new direct oral anticoagulants (dabigatran, rivaroxaban, apixaban, edoxaban) for stroke prevention in nonvalvular atrial fibrillation.
Atrial fibrillation (AF) continues to be a leading cause of cerebrovascular morbidity and mortality resulting from cardioembolic stroke. Oral anticoagulation therapy has been shown to decrease the incidence of cardioembolic stroke in patients with AF by more than 50%. Appropriate use of anticoagulation with vitamin K antagonists requires precise adherence and monitoring. A number of factors that potentially induce patients' dissatisfaction reduce quality of patient life. New direct oral anticoagulants, such as the direct factor Xa inhibitors rivaroxaban, apixaban, edoxaban, and the thrombin inhibitor dabigatran, were developed to overcome the limitations of the conventional anticoagulant drugs. However, models to optimize the benefit of therapy and to ensure that therapy can be safely continued are missing for the new oral anticoagulants. This review will briefly describe the new oral anticoagulants dabigatran, rivaroxaban, apixaban, and edoxaban with focus on their use for prevention of embolic events in AF. Moreover, it will discuss the safety, efficacy, cost data, and benefit for patients' quality of life and adherence.
Mani et al. (2014) conducted a review in Nonvalvular atrial fibrillation. New direct oral anticoagulants (dabigatran, rivaroxaban, apixaban, edoxaban) vs. Vitamin K antagonists was evaluated. Oral anticoagulation therapy decreases the incidence of cardioembolic stroke in patients with atrial fibrillation by more than 50%, with new direct oral anticoagulants aiming to overcome VKA limitations.