A New Era of Oral Anticoagulation in Atrial Fibrillation: Implications in Clinical Practice

Abstract

For > 50 years, vitamin K antagonists were the only available oral drugs for the prevention of thromboembolism in patients with atrial fibrillation. Recently, new oral anticoagulants (the direct thrombin inhibitor dabigatran and the direct activated factor X (factor Xa) inhibitors rivaroxaban and apixaban) have completed phase 3 clinical trials for the same indications. The direct factor Xa inhibitor apixaban was approved by the US Food and Drug Administration in December 2012. In this article, we provide a comprehensive assessment of the safety and efficacy of the new oral anticoagulants. We focus primarily on the balance between thromboembolic and hemorrhagic risk and the implications of such risks in clinical practice. Bleeding and thromboembolic risk estimation tools and their roles in the correct utilization of new oral anticoagulation are also discussed.

Keywords:

• atrial fibrillation
• dabigatran
• rivaroxaban
• apixaban
• new oral anticoagulants
• bleeding
• thromboembolism