Newer Anticoagulants for Atrial Fibrillation: the Role of Dabigatran, Rivaroxaban, Apixaban and Edoxaban / RELY, ROCKET-AF, ARISTOTLE, & ENGAGE AF TIMI 48 Studies/ Safety Issues

Abstract

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia and one of the major risk factors for ischemic stroke and thromboembolic events. Vitamin K antagonists (VKA) are considered to be the cornerstone in antithrombotic therapy for many years. Alternatively, antithrombotic drugs such as aspirin or the combination of aspirin and clopidogrel are also used, but without having proved similar or superior in efficacy compared to VKA. Moreover, therapy with VKA has complications and it is also quite demanding, as it often requires close monitoring of anticoagulation therapy. Recently, newer anticoagulants have been developed, which include direct thrombin antagonists, such as dabigatran or factor Xa inhibitors, such as rivaroxaban, apixaban and edoxaban. For each of these novel drugs large phase III clinical trials have been completed and their results have already been published, with the exception of edoxaban. These drugs are more effective compared to conventional therapies and, furthermore, they lack the need for anticoagulation monitoring. With regards to their safety profile, it has been shown to be similar to VKA. Nevertheless, some reports have recently emerged about fatal bleeding episodes after the use of dabigatran, which highlights the need for evidence based prescription of these novel drugs after thorough patient evaluation.