Adv Ther (2012) 29(6):491–507.
DOI 10.1007/s12325-012-0026-8
REVIEW
Novel Oral Anticoagulants for Stroke Prevention in
Atrial Fibrillation: Focus on Apixaban
Tatjana S. Potpara · Marija M. Polovina · Marina M. Licina · Radan M. Stojanovic · Milica S. Prostran ·
Gregory Y. H. Lip
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Received: April 29, 2012 / Published online: June 7, 2012
© Springer Healthcare 2012
ABSTRACT
Stroke prevention in atrial fibrillation (AF) has
been challenging over decades, mostly due to
a number of difficulties associated with oral
vitamin K antagonists (VKAs), which have
been the most effective stroke prevention
treatment for a long time. The oral direct
thrombin inhibitors (e.g., dabigatran) and oral
direct inhibitors of factor Xa (e.g., rivaroxaban,
apixaban) have emerged recently as an
alternative to VKAs for stroke prevention in AF.
These drugs act rapidly, and have a predictable
and stable dose-related anticoagulant effect with
a few clinically relevant drug–drug interactions.
The novel oral anticoagulants are used in fixed
doses with no need for regular laboratory
monitoring of anticoagulation intensity.
However, each of these drugs has distinct
pharmacological properties that could influence
optimal use in clinical practice.
The following phase 3 randomized trials
with novel oral anticoagulants versus warfarin
for stroke prevention in AF have been
completed: the Randomized Evaluation of
Long-term Anticoagulant therapy (RE-LY) trial
with dabigatran, the Rivaroxaban Once daily
oral direct Factor Xa inhibition Compared
with vitamin K antagonism for prevention of
stroke and Embolism Trial in Atrial Fibrillation
(ROCKET-AF) trial with rivaroxaban, and the
Apixaban for Reduction of Stroke and Other
Thromboembolism Events in Atrial Fibrillation
(ARISTOTLE) trial with apixaban. Moreover, the
Apixaban Versus Acetylsalicylic Acid to prevent
Strokes (AVERROES) trial included patients
with AF who have failed or were unsuitable
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T. S. Potpara ()
Faculty of Medicine, University of Belgrade, Serbia
Cardiology Clinic, Clinical Center of Serbia, Visegradska
26, 11000 Belgrade, Serbia
e-mail: tanjapotpara@gmail.com
M. M. Polovina · M. M. Licina
Cardiology Clinic, Clinical Center of Serbia, 11000
Belgrade, Serbia
R. M. Stojanovic · M. S. Prostran
Department of Pharmacology, Clinical Pharmacology
and Toxicology, Faculty of Medicine, University of
Belgrade, 11000 Belgrade, Serbia
G. Y. H. Lip
University of Birmingham Centre for Cardiovascular
Sciences, City Hospital, Birmingham, UK