Antithrombotic alternatives for stroke prevention in atrial fibrillation: critical differences and remaining questions

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Abstract

Three therapeutic alternatives for prevention of stroke in patients with atrial fibrillation are available in dabigatran (an oral direct thrombin inhibitor), rivaroxaban, and apixaban (both oral blood coagulation factor Xa inhibitors). Compared with warfarin, these new agents have a more predictable pharmacodynamic response and fewer major clinically relevant drug–drug interactions. These agents also have few, if any, food–drug interactions, and infrequent or no need for routine laboratory monitoring. These agents also bring new disadvantages, particularly lack of clearly defined reversal strategies, inability to effectively monitor patient response, and higher cost. Selection of the most appropriate oral antithrombotic agent for a given patient is dependent on clinician knowledge of the similarities and critical differences between the available antithrombotic medications.

Keywords: stroke; dabigatran; rivaroxaban; apixaban; antithrombotic; atrial fibrillation

Citation: Kalus JS. Antithrombotic alternatives for stroke prevention in atrial fibrillation: critical differences and remaining questions. Drugs in Context 2013;212251. doi: 10.7573/dic.212251

Provenance: Invited; externally peer reviewed

Dates: Submitted: 1 March 2013; Accepted, subject to peer review: 5 March 2013; Published: 16 April 2013

Copyright: © 2013 Kalus JS. This is an open-access article distributed under the terms of the Creative Commons Attribution License Deed CC BY NC ND 3.0 which allows anyone to copy, distribute and transmit the article provided it is properly attributed in the manner specified below. No other uses without permission.

Correct attribution: Copyright © 2014 Kalus JS. http://dx.doi.org/10.7573/dic.212251. Published by Drugs in Context under Creative Commons Attribution License Deed CC BY NC ND 3.0.

Correspondence: James S Kalus, PharmD, BCPS (AQ CV), Senior Manager, Patient Care Services, Henry Ford Hospital, Detroit, MI 48202, USA

Email: Jkalus1@hfhs.org

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