Skip to main content
SpringerLink
Log in
Book cover

Atrial Fibrillation Therapy pp 55–89Cite as

Novel Oral Anticoagulants for Stroke Prevention in Patients with Non-valvular Atrial Fibrillation

  • Chapter
  • First Online:

  • 1479 Accesses

Part of the book series: Current Cardiovascular Therapy ((CCT))

Abstract

Atrial fibrillation (AF) is the cause of ischemic stroke in approximately 20 % of patients with stroke [1]. As compared with other etiologies stroke in patients with AF is associated with higher mortality, severe disability and high recurrence rate. Antithrombotic therapy is effective to prevent stroke in AF patients. Vitamin K Antagonists (VKA) are much more effective than aspirin and, in the absence of contraindication, are highly recommended for the majority of these patients [1, 2]. However, warfarin (a VKA) have numerous limitations (narrow therapeutic range, multiple interactions with diet and other medications, complex individualized dosing, delayed onset of action, etc.), which complicate its use [1, 2]. Target International Normalized Ratio (INR) is determined by the balance between the risk of thrombotic events and that of the catastrophic intracranial bleed. Stable therapeutic anticoagulation requires multiple blood tests and is very often hard to achieve, leading to suboptimal balance between thrombosis and bleeding. Novel Oral Anticoagulants (NOACs) were developed to overcome these limitations [3, 4]. The NOACs are divided into two classes: the oral direct thrombin inhibitors (e.g. dabigatran) and oral direct factor Xa inhibitors (e.g. rivaroxaban, apixaban and edoxaban). These agents inhibit a single step in coagulation, at major variance from warfarin, which block the formation of multiple vitamin K-dependent coagulation factors (II, VII, IX, and X).

This is a preview of subscription content, log in via an institution.

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   39.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   54.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

References

  1. Camm AJ, Kirchhof P, Lip GY, et al. Guidelines for the management of atrial fibrillation: the task force for the management of atrial fibrillation of the European Society of Cardiology (ESC). Europace. 2010;12:1360–420.

    Article  PubMed  Google Scholar 

  2. De Caterina R, Husted S, Wallentin L, et al. Anticoagulants in heart disease: current status and perspectives. Eur Heart J. 2007;28:880–913.

    Article  PubMed  Google Scholar 

  3. Camm AJ, Lip GYH, Atar D, et al. 2012 focused update of the ESC guidelines for the management of atrial fibrillation. Eur Heart J. 2012;33:2719–47.

    Article  PubMed  Google Scholar 

  4. Ezekowitz MD, Connolly SJ, Parekh A, et al. Rationale and design of RE-LY: randomized evaluation of long-term anticoagulant therapy, warfarin, compared with dabigatran. Am Heart J. 2009;157:805–10.

    Article  PubMed  CAS  Google Scholar 

  5. Connolly SJ, Ezekowitz MD, Yusuf S, et al. Dabigatran versus warfarin in patients with atrial fibrillation. N Engl J Med. 2009;361:1139–51.

    Article  PubMed  CAS  Google Scholar 

  6. Connolly SJ, Ezekowitz MD, Yusuf S, et al. Newly identified events in the RE-LY trial. N Engl J Med. 2010;363:1875–6.

    Article  PubMed  CAS  Google Scholar 

  7. Ezekowitz MD, Wallentin L, Connolly SJ, et al.; RE-LY Steering Committee and Investigators. Dabigatran and warfarin in vitamin K antagonist-naive and-experienced cohorts with atrial fibrillation. Circulation 2010;122:2246–53.

    Google Scholar 

  8. Patel MR, Mahaffey KW, Garg J, et al. Rivaroxaban versus warfarin in nonvalvular atrial fibrillation. N Engl J Med. 2011;365:883–9.

    Article  PubMed  CAS  Google Scholar 

  9. Connolly SJ, Eikelboom J, Joyner C, et al. Apixaban in patients with atrial fibrillation. N Engl J Med. 2011;364:806–17.

    Article  PubMed  CAS  Google Scholar 

  10. Granger CB, Alexander JH, McMurray JJ, et al.; ARISTOTLE Committees and Investigators. Apixaban vs. warfarin in patients with atrial fibrillation. N Engl J Med. 2011;365:981–92.

    Google Scholar 

  11. ROCKET AF Study Investigators. Rivaroxaban — once daily, oral, direct factor Xa inhibition compared with vitamin K antagonism for prevention of stroke and embolism trial in atrial fibrillation: rationale and design of the ROCKET AF study. Am Heart J. 2010;159:340.e1–7.e1.

    Google Scholar 

  12. Lopes RD, Alexander JH, Al-Khatib SM, et al. Apixaban for reduction in stroke and other thromboemboLic events in atrial fibrillation (ARISTOTLE) trial: design and rationale. Am Heart J. 2010;159:331–9.

    Article  PubMed  CAS  Google Scholar 

  13. Mueck W, Lensing A, Agnelli G, et al. Rivaroxaban: population pharmacokinetic analyses in patients treated for acute deep-vein thrombosis and exposure simulations in patients with atrial fibrillation treated for stroke prevention. Clin Pharmacokinet. 2011;50:675–86.

    Article  PubMed  CAS  Google Scholar 

  14. Weitz JI, Connolly SJ, Patel I, et al. Randomised, parallel-group, multicentre, multinational phase 2 study comparing edoxaban, an oral factor Xa inhibitor, with warfarin for stroke prevention in patients with atrial fibrillation. Thromb Haemost. 2010;104:633–41.

    Article  PubMed  CAS  Google Scholar 

  15. Rosendaal FR, Cannegieter SC, van der Meer FJ, Briet E. A method to determine the optimal intensity of oral anticoagulant therapy. Thromb Haemost. 1993;69:236–9.

    PubMed  CAS  Google Scholar 

  16. Lip GYH, Larsen TB, Skjøth F, et al. Indirect comparisons of new oral anticoagulant drugs for efficacy and safety when used for stroke prevention in atrial fibrillation. J Am Coll Cardiol. 2012;60:738–46.

    Article  PubMed  CAS  Google Scholar 

  17. Dentali F, Riva N, Crowther M, et al. Efficacy and safety of the novel oral anticoagulants in atrial fibrillation: a systematic review and meta-analysis of the literature. Circulation. 2012;126(20):2381–91 published online October 15, 2012.

    Article  PubMed  CAS  Google Scholar 

  18. Weitz JI, Bates SM. New anticoagulants. J Thromb Haemost. 2005;3:1843–53.

    Article  PubMed  CAS  Google Scholar 

  19. Smith P, Arnesen H, Holme I. The effect of warfarin on mortality and reinfarction after myocardial infarction. N Engl J Med. 1990;323:1505–11.

    Article  Google Scholar 

  20. Hurlen M, Abdelnoor M, Smith P, Erikssen J, Arnesen H. Warfarin, aspirin, or both after myocardial infarction. N Engl J Med. 2002;347:969–74.

    Article  PubMed  CAS  Google Scholar 

  21. Lip GY, Huber K, Andreotti F, et al. Management of antithrombotic therapy in atrial fibrillation patients presenting with acute coronary syndrome and/or undergoing percutaneous coronary intervention/stenting. Thromb Haemost. 2010;103:13–28.

    Article  PubMed  CAS  Google Scholar 

  22. Faxon DP, Eikelboom JW, Berger PB, et al. Consensus document: antithrombotic therapy in patients with atrial fibrillation undergoing coronary stenting. A North-American perspective. Thromb Haemost. 2011;106:572–84.

    Article  PubMed  CAS  Google Scholar 

  23. Connolly S, Pogue J, Hart R, et al. Clopidogrel plus aspirin versus oral anticoagulation for atrial fibrillation in the Atrial fibrillation Clopidogrel Trial with Irbesartan for prevention of Vascular Events (ACTIVE W): a randomised controlled trial. Lancet. 2006;367:1903–12.

    Article  PubMed  CAS  Google Scholar 

  24. Hansen ML, Sørensen R, Clausen MT, et al. Risk of bleeding with single, dual, or triple therapy with warfarin, aspirin, and clopidogrel in patients with atrial fibrillation. Arch Intern Med. 2010;170:1433–41.

    Article  PubMed  CAS  Google Scholar 

  25. Dewilde WJM, Oirbans T, Verheugt FWA, et al. Use of clopidogrel with or without aspirin in patients taking oral anticoagulant therapy and undergoing percutaneous coronary intervention: an open-label, randomised, controlled trial. Lancet. 2013;381(9872):1107–15.

    Article  PubMed  CAS  Google Scholar 

  26. Becker E, Perzborn E, Klipp A, et al. Effects of rivaroxaban ASA and clopidogrel alone and in combination in a porcine model of stent thrombosis. Eur Heart J. 2010;31:904.

    Google Scholar 

  27. Mega JL, Braunwald E, Wiviott SD, et al.; for the ATLAS ACS 2-TIMI 51 Investigators. Rivaroxaban in patients with a recent acute coronary syndrome. N Engl J Med. 2012;366:9–19.

    Google Scholar 

  28. Dans AL, Connolly SJ, Wallentin L, et al. Concomitant use of antiplatelet therapy with dabigatran or warfarin in the Randomized Evaluation of Long-term Anticoagulation Therapy (RE-LY) trial. Circulation. 2013;127:634–40.

    Article  PubMed  CAS  Google Scholar 

  29. Van de Werf F, Brueckman M, Connolly SJ, et al. A comparison of dabigatran etexilate with warfarin in patients with mechanical heart valves: the randomized, phase II study to evaluate the safety and pharmacokinetics of oral dabigatran etexilate in patients after heart valve replacement (RE-ALIGN). Am Heart J. 2012;163:931–7.

    Article  PubMed  Google Scholar 

  30. FDA Drug Safety Communication: Pradaxa (dabigatran etexilate mesylate) should not be used in patients with mechanical prosthetic heart valves. www.fda.gov/Drugs/DrugSafety/ucm332912.htm

  31. Weitz JI. New oral anticoagulants: a view from the laboratory. Am J Hematol. 2012;87:S133–6.

    Article  PubMed  CAS  Google Scholar 

  32. Orfeo T, Gissel M, Butenas S, et al. Anticoagulants and the propagation phase of thrombin generation. PLoS One. 2011;6:e27852 (Epub ahead of print).

    Article  PubMed  CAS  Google Scholar 

  33. Lauer A, Ciancetti FA, Van Cott EM, et al. Anticoagulation with the oral direct thrombin inhibitor dabigatran does not enlarge hematoma volume in experimental intracerebral hemorrhage. Circulation. 2011;124:1654–62.

    Article  PubMed  CAS  Google Scholar 

  34. ESC Working Group on Thrombosis. Task force on anticoagulants in heart disease position paper. J Am Coll Cardiol. 2012;59(16):1413–25.

    Article  Google Scholar 

  35. Tripodi A. Problems and solutions for testing hemostasis assays whilst patients are on anticoagulants. Semin Thromb Hemost. 2012;38:586–92.

    Article  PubMed  CAS  Google Scholar 

  36. Funk DM. Coagulation assays and anticoagulant monitoring. Hematol Am Soc Hematol Educ Program. 2012;2012:460–5.

    Google Scholar 

  37. Pradaxa (dabigatran etexilate mesylate) capsules [prescribing information]. Ridgefield: Boehringer Ingelheim Pharmaceuticals, Inc; 2012.

    Google Scholar 

  38. van Ryn J, Stangier J, Haertter S, et al. Dabigatran etexilate – a novel, reversible, oral direct thrombin inhibitor: interpretation of coagulation assays and reversal of anticoagulant activity. Thromb Haemost. 2010;103:1116–27.

    Article  PubMed  Google Scholar 

  39. Huisman MV, Lip GY, Diener HC, Brueckmann M, van Ryn J, Clemens A. Dabigatran etexilate for stroke prevention in patients with atrial fibrillation: resolving uncertainties in routine practice. Thromb Haemost. 2012;107:838–47.

    Article  PubMed  CAS  Google Scholar 

  40. Eriksson BI, Quinlan DJ, Weitz JI. Comparative pharmacodynamics and pharmacokinetics of oral direct thrombin and factor xa inhibitors in development. Clin Pharmacokinet. 2009;48:1–22.

    Article  PubMed  CAS  Google Scholar 

  41. Samama MM, Guinet C. Laboratory assessment of new anticoagulants. Clin Chem Lab Med. 2011;49:761–72.

    Article  PubMed  CAS  Google Scholar 

  42. Lindahl TL, Baghaei F, Blixter IF, et al. Effects of the oral, direct thrombin inhibitor dabigatran on five common coagulation assays. Thromb Haemost. 2011;105:371–8.

    Article  PubMed  CAS  Google Scholar 

  43. Freyburger G, Macouillard G, Labrouche S, et al. Coagulation parameters in patients receiving dabigatran etexilate or rivaroxaban: two observational studies in patients undergoing total hip or total knee replacement. Thromb Res. 2011;127:457–65.

    Article  PubMed  CAS  Google Scholar 

  44. Hillarp A, Baghaei F, Fagerberg IB, et al. Effects of the oral, direct factor Xa inhibitor rivaroxaban on commonly used coagulation assays. J Thromb Haemost. 2011;9:133–9.

    Article  PubMed  CAS  Google Scholar 

  45. Mani H, Wagner C, Lindhoff-Last E (2011) Influence of new anticoagulants on coagulation tests. White paper. Siemens Healthcare Diagnostics Inc. www.healthcare.siemens.com/laboratory-diagnostics

  46. Stangier J, Feuring M. Using the HEMOCLOT direct thrombin inhibitor assay to determine plasma concentrations of dabigatran. Blood Coagul Fibrinolysis. 2012;23:138–43.

    Article  PubMed  CAS  Google Scholar 

  47. Raghavan N, Frost CE, Yu Z, et al. Apixaban metabolism and pharmacokinetics after oral administration to humans. Drug Metab Dispos. 2009;37:74–81.

    Article  PubMed  CAS  Google Scholar 

  48. Rohde G. Determination of rivaroxaban – a novel, oral, direct Factor Xa inhibitor – in human plasma by high-performance liquid chromatography-tandem mass spectrometry. J Chromatogr B Analyt Technol Biomed Life Sci. 2008;872:43–50.

    Article  PubMed  CAS  Google Scholar 

  49. Van Ryn J, Litzenburger T, Waterman A, et al. Dabigatran anticoagulant activity is neutralized by an antibody selective to dabigatran in in vitro and in vivo models. J Am Coll Cardiol. 2011;57:E1130.

    Article  Google Scholar 

  50. Lu G, DeGuzman FR, Lakhotia S, et al. Recombinant antidote for reversal of anticoagulation by factor Xa inhibitors. ASH Annu Meeting Abstr. 2008;112:983.

    Google Scholar 

  51. Lu GP, Peng L, Hollenbach SJ, et al. Reconstructed recombinant factor Xa as an antidote to reverse anticoagulation by factor Xa inhibitors. J Thromb Haemost. 2009;7:309.

    Google Scholar 

  52. Zhou W, Schwarting S, Illanes S, et al. Hemostatic therapy in experimental intracerebral hemorrhage associated with the direct thrombin inhibitor dabigatran. Stroke. 2011;42:3594–9.

    Article  PubMed  Google Scholar 

  53. Eerenberg ES, Kamphuisen PW, Sijpkens MK, et al. Reversal of rivaroxaban and dabigatran by prothrombin complex concentrate: a randomized, placebo-controlled, crossover study in healthy subjects. Circulation. 2011;124:1573–9.

    Article  PubMed  CAS  Google Scholar 

  54. Wolzt M, Levi M, Sarich TC, et al. Effect of recombinant factor VIIa on melagatran-induced inhibition of thrombin generation and platelet activation in healthy volunteers. Thromb Haemost. 2004;91:1090–6.

    PubMed  CAS  Google Scholar 

  55. Gruber A, Marzec UM, Buetehorn U, et al. Potential of activated prothrombin complex concentrate and activated factor VII to reverse the anticoagulant effects of rivaroxaban in primates. ASH Annu Meeting Abstr. 2008;112:3825.

    Google Scholar 

  56. Escolar G, Arellano-Rodrigo E, Reverter JC, et al. Reversal of apixaban induced alterations of hemostasis by different coagulation factor concentrates: studies in vitro with circulating human blood. Circulation. 2012;126:520–1.

    Article  Google Scholar 

  57. Stangier J, Rathgen K, Stahle H, et al. Influence of renal impairment on the pharmacokinetics and pharmacodynamics of oral dabigatran etexilate: an open-label, parallel-group, single-centre study. Clin Pharmacokinet. 2010;49:259–68.

    Article  PubMed  CAS  Google Scholar 

  58. Nowak G. The ecarin clotting time, a universal method to quantify direct thrombin inhibitors. Pathophysiol Haemost Thromb. 2003;33:173–83.

    Article  PubMed  CAS  Google Scholar 

  59. Barrett YC, Wang Z, Frost C, et al. Clinical laboratory measurement of direct factor Xa inhibitors: anti-Xa assay is preferable to prothrombin time assay. Thromb Haemost. 2010;104:1263–71.

    Article  PubMed  CAS  Google Scholar 

  60. Siegal DM, Crowther MA. Acute management of bleeding in patients on novel oral anticoagulants. Eur Heart J. 2013;34:489–98.

    Article  PubMed  CAS  Google Scholar 

  61. Kearon C, Hirsh J. Management of anticoagulation before and after elective surgery. N Engl J Med. 1997;336:1506–11.

    Article  PubMed  CAS  Google Scholar 

  62. Caliendo FJ, Halpern VJ, Marini CP, et al. Warfarin anticoagulation in the perioperative period: is it safe? Ann Vasc Surg. 1999;13:11–6.

    Article  PubMed  CAS  Google Scholar 

  63. Baker WL, Cios DA, Sander SD. Meta-analysis to assess the quality of warfarin control in atrial fibrillation patients in the United States. J Manag Care Pharm. 2009;15:244–52.

    PubMed  Google Scholar 

  64. De Caterina R, Husted S, Wallentin L, et al. New oral anticoagulants in atrial fibrillation and acute coronary syndromes. J Am Coll Cardiol. 2012;59:1413–25.

    Article  PubMed  Google Scholar 

  65. Sie P, Samamab CM, Godier A, et al. Surgery and invasive procedures in patients on long-term treatment with direct oral anticoagulants: thrombin or factor-Xa inhibitors. Recommendations of the working group on perioperative haemostasis and the French study group on thrombosis and haemostasis. Arch Cardiovasc Dis. 2011;104:669–76.

    Article  PubMed  Google Scholar 

  66. Douketis JD. Pharmacologic properties of the new oral anticoagulants: a clinician-oriented review with a focus on perioperative management. Curr Pharm Des. 2010;16:3436–41.

    Article  PubMed  CAS  Google Scholar 

  67. Douketis JD, Spyropoulos AC, Spencer FA, et al. Perioperative management of antithrombotic therapy: antithrombotic therapy and prevention of thrombosis, 9th ed.: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012;141(2):e326S–50.

    PubMed  CAS  Google Scholar 

  68. Douketis JD, Johnson JA, Turpie AG. Low-molecular- weight heparin as bridging anticoagulation during interruption of warfarin: assessment of a standardized periprocedural anticoagulation regimen. Arch Intern Med. 2004;164:1319–26.

    Article  PubMed  CAS  Google Scholar 

  69. Alikhan R, et al. The acute management of haemorrhage, surgery and overdose in patients receiving dabigatran. Emerg Med J. 2013;0:1–6. doi:10.1136/emermed-2012-201976.

    Google Scholar 

  70. Hankey GJ, Eikelboom JW. Dabigatran etexilate: a new oral thrombin Inhibitor. Circulation. 2011;123:1436–50.

    Article  PubMed  Google Scholar 

  71. Spyropoulos AC, Douketis JD. How I treat anticoagulated patients undergoing an elective procedure or surgery. Blood. 2012;120:2954–62.

    Article  PubMed  CAS  Google Scholar 

  72. Golembiewski J, Chernin E, Chopra T. Prevention and treatment of postoperative nausea and vomiting. Am J Health Syst Pharm. 2005;62:1247–60.

    Article  PubMed  CAS  Google Scholar 

  73. Stangier J, Stahle H, Rathgen K, Fuhr R. Pharmacokinetics and pharmacodynamics of the direct oral thrombin inhibitor dabigatran in healthy elderly subjects. Clin Pharmacokinet. 2008;47:47–59.

    Article  PubMed  CAS  Google Scholar 

  74. Wanek MR, Horn ET, Elapavaluru S, et al. Safe use of hemodialysis for dabigatran removal before cardiac surgery. Ann Pharmacother. 2012;46:e21.

    Article  PubMed  Google Scholar 

  75. Gogarten W, Vandermeulen E, Van Aken H, et al. Regional anaesthesia and antithrombotic agents: recommendations of the European Society of Anaesthesiology. Eur J Anaesthesiol. 2010;27:999–1015.

    Article  PubMed  CAS  Google Scholar 

  76. Nagarakanti R, Ezekowitz MD, Oldgren J, et al. Dabigatran versus warfarin in patients with atrial fibrillation: an analysis of patients undergoing cardioversion. Circulation. 2011;123:131–6.

    Article  PubMed  CAS  Google Scholar 

  77. Vazquez SR, Johnson SA, Rondina MT. Peri-procedural anticoagulation in patients undergoing ablation for atrial fibrillation. Thromb Res. 2010;126:e69–77.

    Article  PubMed  CAS  Google Scholar 

  78. Viles-Gonzalez JF, Mehta D. Thromboembolic risk and anticoagulation strategies in patients undergoing catheter ablation for atrial fibrillation. Curr Cardiol Rep. 2011;13:38–42.

    Article  PubMed  Google Scholar 

  79. Hakalahti A, Uusimaa P, Ylitalo K. Catheter ablation of atrial fibrillation in patients with therapeutic oral anticoagulation treatment. Europace. 2011;13:640–5.

    Article  PubMed  Google Scholar 

  80. Hussein AA, Martin DO, Saliba W, et al. Radiofrequency ablation of atrial fibrillation under therapeutic international normalized ratio: a safe and efficacious periprocedural anticoagulation strategy. Heart Rhythm. 2009;6:1425–9.

    Article  PubMed  Google Scholar 

  81. Santangeli P, Di Biase L, Sanchez JE. Atrial fibrillation ablation without interruption of anticoagulation. Cardiol Res Pract. 2011;2011:837–41.

    Google Scholar 

  82. Spragg DD, Dalal D, Cheema A, et al. Complications of catheter ablation for atrial fibrillation: incidence and predictors. J Cardiovasc Electrophysiol. 2008;19:627–31.

    Article  PubMed  Google Scholar 

  83. Lakkireddy D, Reddy YM, Di Biase L, et al. Feasibility and safety of dabigatran vs. warfarin for periprocedural anticoagulation in patients undergoing radiofrequency ablation for atrial fibrillation results from a multicenter prospective registry. J Am Coll Cardiol. 2012;59:1168–74.

    Article  PubMed  CAS  Google Scholar 

  84. Behrman RE, Brenner JS, Brown JS, et al. Developing the sentinel system – a national resource for evidence development. N Engl J Med. 2011;364:498–9.

    Article  PubMed  CAS  Google Scholar 

  85. FDA Drug Safety Communication: Update on the risk for serious bleeding events with the anticoagulant Pradaxa (dabigatran). http://www.fda.gov/Drugs/DrugSafety/ucm326580.htm

Download references

Author information

Authors and Affiliations

  1. Heart Institute, Edith Wolfson Medical Center, 58100, Holon, Israel

    Yoseph Rozenman MSc, MD, FACC & Yuri Gluzman

  2. Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel

    Yoseph Rozenman MSc, MD, FACC & Yuri Gluzman

Authors
  1. Yoseph Rozenman MSc, MD, FACC
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yuri Gluzman
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Internal Medicine Clinic & Department of Cardiology, Colentina University Hospital, Bucharest, Romania

    Gheorghe-Andrei Dan

  2. Catalan Institute of Cardiovascular Sciences, Hospital Santa Creu i Sant Pau, Barcelona, Spain

    Antoni Bayés de Luna

  3. Cardiovascular Sciences Research, Centre Division of Clinical Sciences,, St. George's University of London, London, United Kingdom

    John Camm

Rights and permissions

Reprints and permissions

Copyright information

© 2014 Springer-Verlag London

About this chapter

Cite this chapter

Rozenman, Y., Gluzman, Y. (2014). Novel Oral Anticoagulants for Stroke Prevention in Patients with Non-valvular Atrial Fibrillation. In: Dan, GA., Bayés de Luna, A., Camm, J. (eds) Atrial Fibrillation Therapy. Current Cardiovascular Therapy. Springer, London. https://doi.org/10.1007/978-1-4471-5475-4_3

Download citation

  • DOI: https://doi.org/10.1007/978-1-4471-5475-4_3

  • Published:

  • Publisher Name: Springer, London

  • Print ISBN: 978-1-4471-5474-7

  • Online ISBN: 978-1-4471-5475-4

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation