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Clinical trials of direct thrombin and factor Xa inhibitors in atrial fibrillation

Ralph Ah Stewart1

  • 1Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand. RStewart@adhb.govt.nz

Current Opinion in Cardiology
|May 4, 2011
PubMed

Insights

New anticoagulants, dabigatran and rivaroxaban, offer safe and effective stroke risk reduction for atrial fibrillation patients, serving as alternatives to warfarin.

Area of Science:

  • Cardiology
  • Pharmacology
  • Thrombosis Research

Background:

  • Atrial fibrillation increases stroke risk.
  • Warfarin has been the standard anticoagulant but requires dose adjustment.
  • Novel oral anticoagulants offer potential alternatives.

Purpose of the Study:

  • Review large phase 3 trials comparing direct thrombin or factor Xa inhibitors with warfarin.
  • Evaluate efficacy and safety in atrial fibrillation patients at high stroke risk.

Main Methods:

  • Analysis of published large-scale clinical trials.
  • Comparison of direct thrombin inhibitors (e.g., dabigatran) and factor Xa inhibitors (e.g., rivaroxaban, apixaban) against dose-adjusted warfarin.
  • Assessment of outcomes including thromboembolic stroke, systemic embolism, and bleeding risk.

Main Results:

  • Ximelagatran and idraparinux showed efficacy but faced market withdrawal due to toxicity and bleeding.
  • Dabigatran and rivaroxaban demonstrated non-inferior or superior efficacy to warfarin for stroke prevention without increased bleeding.
  • Apixaban showed efficacy against aspirin; warfarin comparison data is pending.

Conclusions:

  • Dabigatran and rivaroxaban are effective and safe alternatives to warfarin.
  • These agents reduce thromboembolic risk in high-risk atrial fibrillation patients.
Abstract

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