Warfarin Versus Thrombin Inhibitor ( Dabigatran ) The RE-LY trial ( 9 , 18 ) showed that treatment with dabigatran , 150 mg , is superior to warfarin in reducing the incidence of the composite outcome of stroke or systemic embolism .
No statistically significant difference was observed between the 2 therapies with regard to major bleeding , myocardial infa rct ion , or
Atrial fibrillation ( AF ) is characterized by uncoordinated atrial activation with consequent deterioration of mechanical function ( 1 ) .
It is the most common sustained cardiac arrhythmia , and according to estimates , 12.1 million Americans will have AF by 2050 ( 2 ) .
Patients with AF have increased risk for embolic stroke , heart failure , and cognitive impairment ; reduced quality of life ; and higher overall mortality ( 35 ) .
Strokes related to AF have been characterized as more severe ( 6 , 7 ) and translate to a substantial economic burden , costing Medicare approximately $ 8 billion annually ( 8) .
Antithrombotic therapies are the mainstays for preventing thromboembolic events in patients with AF .
Oral anticoagulation with vitamin K antagonists ( VKAs ) has long been the gold st and ard therapy for stroke prevention in these patients .
However , the challenges of monitoring VKA therapy and the many associated food and drug interactions have fueled the development of novel therapeutic options .
Currently , 4 direct-acting oral anticoagulants ( DOACs ) are approved for stroke prevention in patients with nonvalvular AF : the thrombin inhibitor dabigatran and the factor Xa inhibitors apixaban , rivaroxaban , and edoxaban .
In addition , procedural interventions , such as left atrial appendage ( LAA ) occlusion devices , are an alternative treatment for patients who are at high risk for bleeding while receiving anticoagulation therapy .
This systematic review up date s previous review s ( 13 ) and aims to compare the effectiveness of the available medical and procedural therapies in preventing thromboembolic events and bleeding complications in patients with AF .
Ischaemic cardiac outcomes in patients with atrial fibrillation treated with vitamin K antagonism or factor Xa inhibition: results from the ROCKET AF trial.
AIMS We investigated the prevalence of prior myocardial infa rct ion ( MI ) and incidence of ischaemic cardiovascular ( CV ) events among atrial fibrillation ( AF ) patients . METHODS AND RESULTS In ROCKET AF , 14 264 patients with nonvalvular AF were r and omized to rivaroxaban or warfarin . The key efficacy outcome for these analyses was CV death , MI , and unstable angina ( UA ) . This pre-specified analysis was performed on patients while on treatment . Rates are per 100 patient-years . Overall , 2468 ( 17 % ) patients had prior MI at enrollment . Compared with patients without prior MI , these patients were more likely to be male ( 75 vs. 57 % ) , on aspirin at baseline ( 47 vs. 34 % ) , have prior congestive heart failure ( 78 vs. 59 % ) , diabetes ( 47 vs. 39 % ) , hypertension ( 94 vs. 90 % ) , higher mean CHADS2 score ( 3.64 vs. 3.43 ) , and fewer prior strokes or transient ischaemic attacks ( 46 vs. 54 % ) . CV death , MI , or UA rates tended to be lower in patients assigned rivaroxaban compared with warfarin [ 2.70 vs. 3.15 ; hazard ratio ( HR ) 0.86 , 95 % confidence interval ( CI ) 0.73 - 1.00 ; P = 0.0509 ] . CV death , MI , or UA rates were higher in those with prior MI compared with no prior MI ( 6.68 vs. 2.19 ; HR 3.04 , 95 % CI 2.59 - 3.56 ) with consistent results for CV death , MI , or UA for rivaroxaban compared with warfarin in prior MI compared with no prior MI ( P interaction = 0.10 ) . CONCLUSION Prior MI was common and associated with substantial risk for subsequent cardiac events . Patients with prior MI assigned rivaroxaban compared with warfarin had a non-significant 14 % reduction of ischaemic cardiac events
Warfarin Versus Thrombin Inhibitor ( Dabigatran ) The RE-LY trial ( 9 , 18 ) showed that treatment with dabigatran , 150 mg , is superior to warfarin in reducing the incidence of the composite outcome of stroke or systemic embolism .
No statistically significant difference was observed between the 2 therapies with regard to major bleeding , myocardial infa rct ion , or
Atrial fibrillation ( AF ) is characterized by uncoordinated atrial activation with consequent deterioration of mechanical function ( 1 ) .
It is the most common sustained cardiac arrhythmia , and according to estimates , 12.1 million Americans will have AF by 2050 ( 2 ) .
Patients with AF have increased risk for embolic stroke , heart failure , and cognitive impairment ; reduced quality of life ; and higher overall mortality ( 35 ) .
Strokes related to AF have been characterized as more severe ( 6 , 7 ) and translate to a substantial economic burden , costing Medicare approximately $ 8 billion annually ( 8) .
Antithrombotic therapies are the mainstays for preventing thromboembolic events in patients with AF .
Oral anticoagulation with vitamin K antagonists ( VKAs ) has long been the gold st and ard therapy for stroke prevention in these patients .
However , the challenges of monitoring VKA therapy and the many associated food and drug interactions have fueled the development of novel therapeutic options .
Currently , 4 direct-acting oral anticoagulants ( DOACs ) are approved for stroke prevention in patients with nonvalvular AF : the thrombin inhibitor dabigatran and the factor Xa inhibitors apixaban , rivaroxaban , and edoxaban .
In addition , procedural interventions , such as left atrial appendage ( LAA ) occlusion devices , are an alternative treatment for patients who are at high risk for bleeding while receiving anticoagulation therapy .
This systematic review up date s previous review s ( 13 ) and aims to compare the effectiveness of the available medical and procedural therapies in preventing thromboembolic events and bleeding complications in patients with AF .