Dabigatran and Myocardial Infarction, Drug or Class Effect. Meta-Analysis of Randomized Trials With Oral Direct Thrombin Inhibitors

Artang, Ramin; Rome, Eric; Vidaillet, Humberto

doi:10.1016/s0735-1097(12)60572-5

Cited by 4 publications

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“…A recent meta-analysis of randomised trials comparing oral direct thrombin inhibitors with warfarin for stroke prevention in AF showed significantly higher MI rates in the dabigatran and combined ximelagatran and dabigatran arm (OR=1.40; 95% CI 1.05 to 1.86 and 1.32; 95% CI 1.05 to 1.66, respectively, both p=0.005), suggesting a class-specific effect 43. On the other hand, a meta-analysis of warfarin versus other treatments demonstrated a lower MI rate with warfarin (RR=0.77; 95% CI 0.63 to 0.95; p<0.01) 44.…”

Section: New Oral Anticoagulants For Thromboprophylaxis In Afmentioning

confidence: 99%

New anticoagulant treatments to protect against stroke in atrial fibrillation

Potpara

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Apostolakis

2012

Heart

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Warfarin has long been the 'gold standard' of oral anticoagulation for stroke prevention in atrial fibrillation (AF). Recently, the oral direct thrombin inhibitors and direct factor Xa inhibitors have emerged as attractive alternatives to warfarin and have already changed the landscape of stroke prevention in AF. The new anticoagulants have important advantages over warfarin. Despite their impressive performance in clinical trials, their long-term efficacy and safety still require evaluation in 'real-world' clinical practice. In this review, the emerging role of the new oral anticoagulants for stroke prevention in patients with AF is discussed.

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Section: New Oral Anticoagulants For Thromboprophylaxis In Afmentioning

confidence: 99%

New anticoagulant treatments to protect against stroke in atrial fibrillation

Potpara

Lip

Apostolakis

2012

Heart

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Neue orale Antikoagulanzien zur Schlaganfallprävention

Berthold

2012

Z Gerontol Geriat

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New oral anticoagulants for the prevention of stroke in patients with nonvalvular atrial fibrillation have been available for a few months, among them the reversible direct thrombin inhibitor dabigatran and the factor Xa antagonist rivaroxaban. These drugs are considered by some as a superior alternative to vitamin K antagonists. The lack of necessity for regular monitoring is advertised as a major advantage. Although atrial fibrillation is a disease with increasing prevalence with higher age, the suitability of the new drugs has not been extensively studied in multimorbid geriatric patients. Since dabigatran is contraindicated in patients with renal insufficiency, only the lower of the two approved dosages can usually be prescribed in elderly patients. For the lower dosage, however, no superiority in prevention of stroke has been documented but merely a reduction in major bleeding rates, although at a high number needed to treat. The requirement for a twice-daily dosage regimen, the lack of an anticoagulation monitoring option, the relatively short duration of action and the lack of an antidote may even prove to be crucial disadvantages in clinical practice in comparison to vitamin K antagonists. Until more data are available, the new oral anticoagulants should be prescribed with caution in geriatric patients.

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Novel Oral Anticoagulants for Stroke Prevention in Atrial Fibrillation: Focus on Apixaban

et al. 2012

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Stroke prevention in atrial fibrillation (AF) has been challenging over decades, mostly due to a number of difficulties associated with oral vitamin K antagonists (VKAs), which have been the most effective stroke prevention treatment for a long time. The oral direct thrombin inhibitors (e.g., dabigatran) and oral direct inhibitors of factor Xa (e.g., rivaroxaban, apixaban) have emerged recently as an alternative to VKAs for stroke prevention in AF. These drugs act rapidly, and have a predictable and stable dose-related anticoagulant effect with a few clinically relevant drug-drug interactions. The novel oral anticoagulants are used in fixed doses with no need for regular laboratory monitoring of anticoagulation intensity. However, each of these drugs has distinct pharmacological properties that could influence optimal use in clinical practice. The following phase 3 randomized trials with novel oral anticoagulants versus warfarin for stroke prevention in AF have been completed: the Randomized Evaluation of Long-term Anticoagulant therapy (RE-LY) trial with dabigatran, the Rivaroxaban Once daily oral direct Factor Xa inhibition Compared with vitamin K antagonism for prevention of stroke and Embolism Trial in Atrial Fibrillation (ROCKET-AF) trial with rivaroxaban, and the Apixaban for Reduction of Stroke and Other Thromboembolism Events in Atrial Fibrillation (ARISTOTLE) trial with apixaban. Moreover, the Apixaban Versus Acetylsalicylic Acid to prevent Strokes (AVERROES) trial included patients with AF who have failed or were unsuitable for warfarin, and compared apixaban versus aspirin for stroke prevention in AF. Overall, apixaban has two large trials for stroke prevention in AF showing benefits not only over warfarin, but also over aspirin among those patients who have failed or refused warfarin. In the ARISTOTLE trial, apixaban was superior to warfarin in the reduction of stroke or systemic embolism, major bleeding, intracranial hemorrhage, and all-cause mortality, with a similar reduction in the rate of ischemic stroke and better tolerability. When compared with aspirin in the AVERROES trial, apixaban was associated with more effective reduction of stroke, a similar risk of major bleeding, and better tolerability. In this review article, the authors summarize the current knowledge on novel oral anticoagulants and discuss the clinical aspects of their use for stroke prevention in AF, with particular emphasis on apixaban.

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Dabigatran and Myocardial Infarction, Drug or Class Effect. Meta-Analysis of Randomized Trials With Oral Direct Thrombin Inhibitors

Cited by 4 publications

References 0 publications

New anticoagulant treatments to protect against stroke in atrial fibrillation

New anticoagulant treatments to protect against stroke in atrial fibrillation

Neue orale Antikoagulanzien zur Schlaganfallprävention

Novel Oral Anticoagulants for Stroke Prevention in Atrial Fibrillation: Focus on Apixaban

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