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Novel oral anticoagulants and stroke prevention in atrial fibrillation and chronic heart failure

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Abstract

Heart failure (HF) and atrial fibrillation (AF) frequently coexist and share a reciprocal relationship. The presence of AF increases the propensity to HF and can worsen its severity as well as escalating the risk of stroke. Despite the proven efficacy of vitamin K antagonists and warfarin for stroke prevention in AF, their use is beset by numerous problems. These include their slow onset and offset of action, unpredictability of response, the need for frequent coagulant monitoring and serious concerns around the increased risks of intracranial and major bleeding. Three recently approved novel anticoagulants (dabigatran, rivaroxaban and apixaban) are already challenging warfarin use in AF. They have a predictable therapeutic response and a wide therapeutic range and do not necessitate coagulation monitoring. In this article, the relationship between HF and AF and the mechanisms for their compounded stroke risk are reviewed. The evidence to support the use of these three NOACs amongst patients with AF and HF is further explored.

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Conflict of interest

Dr. Boos has received monies for speaking for Pfizer/BMS and Boehringer-Ingelheim and has been an advisor for Pfizer/BMS. Professor Camm has acted as an advisor for Bayer, Pfizer/BMS, Daiichi and Boehringer-Ingelheim. Dr. Michael Nam has no conflict of interest to declare.

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Authors and Affiliations

  1. Department of Cardiology, Poole Hospital NHS Foundation Trust, Longfleet Rd., Poole, Dorset, BH15 2JB, UK

    Christopher J. Boos & Michael Nam

  2. Department of Postgraduate Medical Education, Bournemouth University, Bournemouth, UK

    Christopher J. Boos

  3. Division of Clinical Sciences, St. George’s University of London, London, UK

    A. J. Camm

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  1. Christopher J. Boos
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  2. Michael Nam
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  3. A. J. Camm
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Correspondence to Christopher J. Boos.

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Boos, C.J., Nam, M. & Camm, A.J. Novel oral anticoagulants and stroke prevention in atrial fibrillation and chronic heart failure. Heart Fail Rev 19, 391–401 (2014). https://doi.org/10.1007/s10741-013-9398-3

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  • DOI: https://doi.org/10.1007/s10741-013-9398-3

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