ANTITHROMBOTIC THERAPY IN ATRIAL FIBRILLATION: NEW DATA AND NEW HORIZONS
https://doi.org/10.20996/1819-6446-2011-7-1-75-81
Abstract
New data and perspectives of antithrombotic therapy are highlighted in patients with atrial fibrillation. Factors of warfarin therapy efficacy, as well as the possibility of new antithrombotic drugs are considered. Special attention are paid to the direct thrombin inhibitors — dabigatran. Possibilities and usage prospects of dabigatran in patients with atrial fibrillation are discussed in detail in the light of new results of RE-LY trial.
About the Authors
M. Yu. GilyarovRussian Federation
V. A. Sulimov
Russian Federation
References
1. Hart R.G., Pearce, L.A., Rothbart, R.M. et al. Stroke with intermittent atrial fibrillation: incidence and predictors during aspirin therapy. JACC 2000; 35(1): 183-187.
2. Hart R.G., Pearce, L.A., Koudstaal, P.J. Transient Ischemic Attacks in Patients With Atrial Fibrillation: Implications for Secondary Prevention: The European Atrial Fibrillation Trial and Stroke Prevention in Atrial Fibrillation III Trial. Stroke 2004; 35(4): 948 - 951.
3. Hohnloser S.H., Pajitnev D., Pogue, J. at al. Incidence of Stroke in Paroxysmal Versus Sustained Atrial Fibrillation in Patients Taking Oral Anticoagulation or Combined Antiplatelet Therapy: An ACTIVE W Sub-study. JACC 2007; 50(22): 2156 - 2161.
4. Kannel W.B., Abbott, R.D., Savage D.D., McNamara P.M. Coronary heart disease and atrial fibrillation: the Framingham Study. Am Heart J 1983; 106(2): 389 - 396.
5. Nieuwlaat R., Dinh, T., Olsson S.B. et al. Should we abandon the common practice of withholding oral anticoagulation in paroxysmal atrial fibrillation? Eur Heart J 2008; 29(7): 915 - 922.
6. Hart R.G., Pearce, L.A., Aguilar M.I. Meta-analysis: Antithrombotic Therapy to Prevent Stroke in Patients Who Have Nonvalvular Atrial Fibrillation. Ann Intern Med 2007; 146(12): 857 - 867.
7. The ACTIVE Writing Group. 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(9526): 1903 - 1912.
8. Giliarov M.Iu., Generozov É.V., Magomadova M.U. et al. Factors influencing on warfarin dose in patients with atrial fibrillation. Kardiologiya i serdechno-sosudistaya khirurgiya 2008; 5: 65 - 68. Russian (Гиляров М.Ю., Генерозов Э.В., Магомадова М.У. и др. Факторы, влияющие на дозировку варфарина у пациентов с фибрилляцией предсердий. Кардиология и сердечно-сосудистая хирургия 2008; 5: 65 – 68).
9. Giliarov M.Iu., Generozov É.V., Magomadova M.U. et al. Polymorphism of vitamin K epoxide-reductase subunit 1 gene: prevalence and impact on warfarin dosage among Moscow region inhabitants. Kardiologiya i serdechno-sosudistaya khirurgiya 2009; 3: 36 - 39. Russian (Гиляров М.Ю., Генерозов Э.В., Магомадова М.У. и др. Полиморфизм гена субъединицы 1 витамин К эпоксидредуктазы: распространенность и влияние на дозировку варфарина у жителей Московского региона. Кардиология и сердечно-сосудистая хирургия 2009; 3: 36 – 39).
10. The ACTIVE Investigators. Effect of Clopidogrel Added to Aspirin in Patients with Atrial Fibrillation. N Engl J Med 2009; 360(20): 2066 - 2078.
11. Cleland J.G.F., Cowburn P.J., Falk R.H. Should all patients with atrial fibrillation receive warfarin? Evidence from randomized clinical trials. Eur Heart J 1996; 17(5): 674 - 681.
12. Hylek E.M., Skates S.J., Sheehan M.A., Singer D.E. An Analysis of the Lowest Effective Intensity of Prophylactic Anticoagulation for Patients with Nonrheumatic Atrial Fibrillation. N Engl J Med 1996; 335(8): 540 - 546.
13. Gilyarov M.Yu., Sulimov V.A. Antithrombotic therapy at an atrial fibrillation: old problems and new solutions. Rational Pharmacother Cardiol 2010;6(1):84-88. Russian (Гиляров М.Ю., Сулимов В.А. Антитромботическая терапия при фибрилляции предсердий: старые проблемы и новые решения. Рациональная Фармакотерапия в Кардиологии 2010; 6(1): 84-88).
14. Connolly S.J., Ezekowitz M.D., Yusuf S. et al. Dabigatran versus Warfarin in Patients with Atrial Fibrillation. N Engl J Med 2009; 361(12): 1139 - 1151.
15. Connolly S.J., Ezekowitz M.D., Yusuf S. et al. Newly Identified Events in the RE-LY Trial. N Engl J Med 2010; 363(19): 1875 - 1876.
16. Healey J.S., Eikelboom J., Wallentin L. et al. Effect of age and renal function on the risk of stroke and major bleeding with dabigatran compared to warfarin: an analysis from the RE-LY study. JACC 2010; 55: A4. E37.
17. Oldgren J., Alings M., Darius H. et al. Dabigatran versus warfarin in atrial fibrillation patients with low, moderate and high CHADS2 score: a RE-LY subgroup analysis. JACC 2010; 55: A1. E2.
18. Diener H.-C., Connolly S.J., Ezekowitz M.D. et al. Dabigatran compared with warfarin in patients with atrial fibrillation and previous transient ischaemic attack or stroke: a subgroup analysis of the RE-LY trial. Lancet Neurology 2010; 9(12): 1157 - 1163.
19. Lane D.A., Lip G.Y.H. Dabigatran in atrial fibrillation: balancing secondary stroke prevention against bleeding risk. Lancet Neurology 2010; 9(12): 1140 - 1142.
20. Ezekowitz M.D., Wallentin L., Connolly S.J. et al. Comparison between the effects of dabigatran versus warfarin in Vitamin K antagonist naive and experienced patients with atrial fibrillation in the the RE-LY Trial. Circulation 2010; 122(22): 2246 - 2253.
21. Wallentin L., Yusuf S., Ezekowitz M.D. et al. Efficacy and safety of dabigatran compared with warfarin at different levels of international normalised ratio control for stroke prevention in atrial fibrillation: an analysis of the RE-LY trial. Lancet 2010; 376(9745): 975 - 983.
22. Nagarakanti R., Ezekowitz M.D., Oldgren J. at al. Dabigatran versus warfarin in patients with atrial fibrillation: an analysis of patients undergoing cardioversion. Circulation 2011; 123(2):131-6.
23. Roskel N.S., Lip G.Y.H., Noak H. et al. Treatments for stroke prevention in atrial fibrillation: A network meta-analyses and indirect comparisons versus dabigatran etexilate. Thromb Haemost 2010; 104(6): 1106 - 1115.
24. Ahrens I., Lip G.Y., Peter K. What do the RE-LY, AVERROES and ROCKET-AF trials tell us for stroke prevention in atrial fibrillation? Thromb Haemost 2011;105(4). [Epub ahead of print].
25. Lopes R.D., Alexander J.H., Al-Khatib S.M. et al.; ARISTOTLE Investigators. Apixaban for reduction in stroke and other ThromboemboLic events in atrial fibrillation (ARISTOTLE) trial: design and rationale. Am Heart J 2010;159(3):331-9.
Review
For citations:
Gilyarov M.Yu., Sulimov V.A. ANTITHROMBOTIC THERAPY IN ATRIAL FIBRILLATION: NEW DATA AND NEW HORIZONS. Rational Pharmacotherapy in Cardiology. 2011;7(1):75-81. (In Russ.) https://doi.org/10.20996/1819-6446-2011-7-1-75-81