Abstract
Patients with AF have a fivefold increased risk of stroke, particularly in patients with valvular heart disease and in the elderly. It is estimated that 15–20 % of all strokes are attributable to AF. Four new agents [apixaban, dabigatran, edoxaban, and rivaroxaban] are vying to replace or greatly reduce the use of the well-tried warfarin. There is little doubt that warfarin is underused and in many the international normalized ratio [INR] is not in the desired range 2–3.
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Abrams PJ, Emerson CR. Rivaroxaban: a novel, oral, direct factor Xa inhibitor. Pharmacotherapy. 2009;29:167–81.
Ansell J. Should newer oral anticoagulants be used as first-line agents to prevent thromboembolism in patients with atrial fibrillation and risk factors for stroke or thromboembolism?: new oral anticoagulants should not be used as first-line agents to prevent thromboembolism in patients with atrial fibrillation. Circulation. 2012;125:165–70.
ARISTOTLE, Granger CB, Alexander JH, McMurray JJV, et al. Apixaban.GRANGER IS IN versus warfarin in patients with atrial fibrillation. N Engl J Med. 2011;365:981–92.
Avorn J. The relative cost-effectiveness of anticoagulants: obvious, except for the cost and the effectiveness. Circulation. 2011;123:2519–21.
Bhatt DL, Stone GW, Mahaffey KW, et al. Effect of platelet inhibition with cangrelor during PCI on ischemic events. N Engl J Med. 2013;368:1303–13.
Cleland JGF, Teerlink JR, Senior R, et al. The effects of the cardiac myosin activator, omecamtiv mecarbil, on cardiac function in systolic heart failure: a double-blind, placebo-controlled, crossover, dose-ranging phase 2 trial. Lancet. 2011;378:676–83.
Connolly SJ, EzekowitzMD, Yusuf S, et al. Dabigatran versus warfarin in patients with atrial fibrillation. N Engl J Med. 2009;361:1139–51. (and the RE-LY Steering Committee and Investigators).
Connolly SJ, Eikelboom J, Joyner C, et al. for the AVERROES Steering Committee and Investigators .Apixaban in patients with atrial fibrillation. N Engl J Med. 2011;364:806–17.
Eikelboom JW, Weitz JI. New anticoagulants. Circulation. 2010;121: 1523–32.
Gage BF. Can we rely on RE-LY? N Engl J Med. 2009;361:1200–2.
Giles TD, Weber MA, Basile J, for the NAC-MD-01 Study Investigators, et al. Efficacy and safety of nebivolol and valsartan as fixed-dose combination in hypertension: a randomised, multicentre study. Lancet. 2014;383:1889–98.
Giugliano RP, Ruff CT, Braunwald E, et al. Edoxaban versus warfarin in patients with atrial fibrillation. N Engl J Med. 2013;369(22):2093–104.
Gurbel PA, Bliden KP, Butler K, et al. Randomized double-blind assessment of the ONSET and OFFSET of the antiplatelet effects of ticagrelor versus clopidogrel in patients with stable coronary artery disease: the ONSET/OFFSET study. Circulation. 2009;120(2577–2585):2009.
Hylek EM, Held C, Alexander JH, et al. Major bleeding in patients with atrial fibrillation receiving apixaban or warfarin The ARISTOTLE Trial (Apixaban for reduction in stroke and other thromboembolic events in atrial fibrillation) Predictors, characteristics, and clinical outcomes. J Am Coll Cardiol. 2014;63(20):2141–7.
Lange RA, Hillis LD. The duel between dual antiplatelet therapies. N Engl J Med. 2013;368:1356–7.
Mega JL, Braunwald E, Wiviott SD, et al. Rivaroxaban in patients with a recent acute coronary syndrome. N Engl J Med. 2012;366:9–19.
Nicholls SJ, Ballantyne CM, Barter PJ, et al. Effect of two intensive statin regimens on progression of coronary disease. N Engl J Med. 2011;365:2078–87.
PLATO (for the PLATelet inhibition and patient Outcomes investigators), Cannon CP, Harrington RA, James S, et al. Comparison of ticagrelor with clopidogrel in patients with a planned invasive strategy for acute coronary syndromes: a randomised double-blind study. Lancet. 2010;375(9711):283–93.
ROCKET: AF, Patel MR, Mahaffey KW, Garg J, et al. Rivaroxaban versus warfarin in nonvalvular atrial fibrillation. N Engl J Med. 2011;365:883–91.
ROCKET AF: Halperin JL, Hankey GJ, Wojdyla DM, On behalf of the ROCKET AF Steering Committee and Investigators. Efficacy and safety of rivaroxaban compared with warfarin among elderly patients with nonvalvular atrial fibrillation in the rivaroxaban once daily, oral, direct factor Xa inhibition compared with vitamin K antagonism for prevention of stroke and embolism trial in atrial fibrillation. Circulation. 2014;130:138–46.
Roe MT, Armstrong PW, Fox KAA, et al. Prasugrel versus clopidogrel for acute coronary syndromes without revascularization. N Engl J Med. 2012;367:1297–309.
Ruff CT, Giugliano RP, Antman EM, Crugnale SE, Bocanegra T, Mercuri M, et al. Evaluation of the novel factor Xa inhibitor edoxaban compared with warfarin in patients with atrial fibrillation: design and rationale for the Effective Anticoagulation With Factor Xa Next Generation in Atrial Fibrillation-Thrombolysis in Myocardial Infarction Study 48 (ENGAGE AF-TIMI 48). Am Heart J. 2010;160:635–41.
SENIORS Investigators, van Veldhuisen DJ, Cohen-Solal A, Bohm M, et al. Beta-blockade with nebivolol in elderly heart failure patients with impaired and preserved left ventricular ejection fraction: data from SENIORS (Study of Effects of Nebivolol Intervention on Outcomes and Rehospitalization in Seniors With Heart Failure). J Am Coll Cardiol. 2009;2009(53):2150–8.
Teerlink JR, Clarke CP, Saikali KG, et al. Dose-dependent augmentation of cardiac systolic function with the selective cardiac myosin activator, omecamtiv mecarbil: a first-in-man study. Lancet. 2011;378:667–75.
Teramoto T, Takeuchi M, Morisaki Y, et al. Efficacy, safety, tolerability, and pharmacokinetic profile of Evacetrapib administered as monotherapy or in combination with Atorvastatin in Japanese patients with dyslipidemia. Am J Cardiol. 2014;113:2021–9.
TRITON-TIMI 38 Investigators, Montalescot G, Wiviott SD, Braunwald E, et al. Prasugrel compared with clopidogrel in patients undergoing percutaneous coronary intervention for ST-elevation myocardial infarction (TRITONTIMI 38): double-blind, randomised controlled trial. Lancet. 2009;373(9665):723–31. (TRITON-TIMI 38 Investigators).
Walenga JM, Adiguzel C. Drug and dietary interactions of the new and emerging oral anticoagulants. Int J Clin Pract. 2010;64:956–67.
Wallentin L, Varenhorst C, James S, et al. Prasugrel achieves greater and faster P2Y12receptor-mediated platelet inhibition than clopidogrel due to more efficient generation of its active metabolite in aspirin-treated patients with coronary artery disease. Eur Heart J. 2008;29:21–30.
Wiviott SD, Trenk D, Frelinger AL, et al. Prasugrel compared with high loading- and maintenance-dose clopidogrel in patients with planned percutaneous coronary intervention: the Prasugrel in comparison to clopidogrel for inhibition of platelet activation and aggregation-thrombolysis in myocardial infarction 44 trial. Circulation. 2007;116:2923–32.
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Khan, M.G. (2015). Newer Agents. In: Cardiac Drug Therapy. Contemporary Cardiology. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-61779-962-4_24
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DOI: https://doi.org/10.1007/978-1-61779-962-4_24
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