The Efficacy of Novel Anticoagulants Compared with Warfarin for Stroke Prevention in Patients with Atrial Fibrillation
| Main Authors: | Nursalim, Alvin; Faculty of Medicine Universitas Indonesia, Jakarta, Setiabudi, Edwin; Faculty of Medicine Maranatha Christian University/Immanuel Hospital, Bandung |
|---|---|
| Format: | application/pdf eJournal |
| Bahasa: | eng |
| Terbitan: |
Journal of the Indonesian Medical Association
, 2012
|
| Online Access: |
http://indonesia.digitaljournals.org/index.php/idnmed/article/view/1272 |
Daftar Isi:
- Warfarin, a vitamin K antagonist, has been used for a long time to prevent stroke in patients with atrial fibrillation (AF) . Despite its high efficacy, warfarin has several limitations. The sought of novel anticoagulants is for aimed at overcome this limitations. Hundred and fifty mg of dabigatran is superior to warfarin regarding stroke prevention (RR 0.64; 95% CI 0.51-0.81, p<0.001). Dabigatran, however, increases the risk of gastrointestinal bleeding. Rivaroxaban (20 mg), is noninferior to warfarin for the prevention of stroke and systemic embolism (HR 0.79, 95% CI 0.66-0.96, p<0.001 for non-inferiority). There was no significant difference in terms of major bleeding. Apixaban (5mg) is superior to warfarin in reducing the occurence of stroke and systemic embolism (HR 0.79; 95%, CI 0.65 to 0.95; p=0.01). Apixaban causes less bleeding. While no guideline available for use of novel anticoagulants , one has to thoroughly consider the following before prescribing: AF patients’ history of tolarable warfarin use, affordability of the drug, frequency of administration, and the safety profile of the drug. J Indon Med Assoc. 2012;62:407-12.Keywords: atrial fibrillation, stroke, warfarin, dabigatran, rivaroxaban, apixaban