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Novel oral Anticoagulants in Non-Valvular Atrial Fibrillation

Atrial fibrillation is the most frequent arrhythmia in clinical practice, reaching 2% of the people in the world and is associated with systemic embolism. Thus, the use of anticoagulants is indicated if CHA2DS2-VASc score ≥2 or in patients with previous transient ischemic attack or stroke. For decad...

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Autor principal: da Silva, Rose M.F.L.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Bentham Science Publishers 2014
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4428103/
https://www.ncbi.nlm.nih.gov/pubmed/25470147
http://dx.doi.org/10.2174/187152571201141201091848
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author da Silva, Rose M.F.L.
author_facet da Silva, Rose M.F.L.
author_sort da Silva, Rose M.F.L.
collection PubMed
description Atrial fibrillation is the most frequent arrhythmia in clinical practice, reaching 2% of the people in the world and is associated with systemic embolism. Thus, the use of anticoagulants is indicated if CHA2DS2-VASc score ≥2 or in patients with previous transient ischemic attack or stroke. For decades, warfarin, a vitamin K antagonist, was the only choice for chronic oral anticoagulation. Recently, novel oral anticoagulants (NOACs) have been introduced, offering similar (or better) effectiveness, safety, and convenience to the vitamin K antagonists. Dabigatran was the first NOAC approved and is a direct thrombin inhibitor. Rivaroxaban and apixaban are factor Xa inhibitors. They display rapid onset of action, more predictable of pharmacological profile, less interactions with other drugs, lack of significant effects in the diet, and less risk of intracranial hemorrhage than warfarin. Despite that dose adjustment is necessary for patients with chronic kidney disease or according to body weight, these new drugs do not require regular monitoring. There are recommendations for the start and follow-up therapy with NOACs, planning for cardioversion, ablation and surgical interventions and the management of bleeding. This article is a review of the major studies of the NOACs. The clinical use of these drugs in patients with non-valvular atrial fibrillation is presented.
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spelling pubmed-44281032015-05-14 Novel oral Anticoagulants in Non-Valvular Atrial Fibrillation da Silva, Rose M.F.L. Cardiovasc Hematol Agents Med Chem Article Atrial fibrillation is the most frequent arrhythmia in clinical practice, reaching 2% of the people in the world and is associated with systemic embolism. Thus, the use of anticoagulants is indicated if CHA2DS2-VASc score ≥2 or in patients with previous transient ischemic attack or stroke. For decades, warfarin, a vitamin K antagonist, was the only choice for chronic oral anticoagulation. Recently, novel oral anticoagulants (NOACs) have been introduced, offering similar (or better) effectiveness, safety, and convenience to the vitamin K antagonists. Dabigatran was the first NOAC approved and is a direct thrombin inhibitor. Rivaroxaban and apixaban are factor Xa inhibitors. They display rapid onset of action, more predictable of pharmacological profile, less interactions with other drugs, lack of significant effects in the diet, and less risk of intracranial hemorrhage than warfarin. Despite that dose adjustment is necessary for patients with chronic kidney disease or according to body weight, these new drugs do not require regular monitoring. There are recommendations for the start and follow-up therapy with NOACs, planning for cardioversion, ablation and surgical interventions and the management of bleeding. This article is a review of the major studies of the NOACs. The clinical use of these drugs in patients with non-valvular atrial fibrillation is presented. Bentham Science Publishers 2014-04 2014-04 /pmc/articles/PMC4428103/ /pubmed/25470147 http://dx.doi.org/10.2174/187152571201141201091848 Text en © 2014 Bentham Science Publishers http://creativecommons.org/licenses/by/3.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.5/), which permits unrestrictive use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Article
da Silva, Rose M.F.L.
Novel oral Anticoagulants in Non-Valvular Atrial Fibrillation
title Novel oral Anticoagulants in Non-Valvular Atrial Fibrillation
title_full Novel oral Anticoagulants in Non-Valvular Atrial Fibrillation
title_fullStr Novel oral Anticoagulants in Non-Valvular Atrial Fibrillation
title_full_unstemmed Novel oral Anticoagulants in Non-Valvular Atrial Fibrillation
title_short Novel oral Anticoagulants in Non-Valvular Atrial Fibrillation
title_sort novel oral anticoagulants in non-valvular atrial fibrillation
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4428103/
https://www.ncbi.nlm.nih.gov/pubmed/25470147
http://dx.doi.org/10.2174/187152571201141201091848
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