Abstract
Objectives: To assess the pharmacologic and clinical benefits of 3 new oral anticoagulants-the direct thrombin inhibitor dabigatran and 2 Factor Xa inhibitors, rivaroxaban and apixaban-in patients with atrial fibrillation (AF).
Study Design: A PubMed literature search was performed using the criteria "atrial fibrillation" and "stroke" with each of the following: "dabigatran," "apixaban," and "rivaroxaban."
Methods: Articles published from January 2009 to October 2011 were analyzed for randomized clinical studies sufficiently powered to identify rates of stroke and non-central nervous system systemic embolism. Subgroup analyses were excluded. Articles were analyzed for randomized, controlled studies enrolling more than 500 patients. A search on www. clinicaltrials. gov was performed to identify additional studies. All searches were performed in January 2011 and updated in October 2011.
Results: All 3 new oral anticoagulants are at least as effective and safe as warfarin for the prevention of stroke and systemic embolism in patients with AF. Given the differences in the patient populations studied, conclusions about the relative efficacy and safety of these agents cannot be made.
Conclusions: The new oral anticoagulants offer potential advantages over warfarin, particularly in terms of key safety end points and ease of use, while achieving a comparable level of protection against stroke in patients with AF. These advantages may increase adherence to therapy, improve clinical outcomes, and decrease overall healthcare costs, providing an increased benefi t for individuals at greatest risk for AF-induced stroke.