New and emerging anticoagulant therapy for atrial fibrillation and acute coronary syndrome

Estella M. Davis, Kathleen A. Packard, Jon T. Knezevich, Jennifer A. Campbell

Research output: Contribution to journalReview article

31 Citations (Scopus)

Abstract

Thrombosis is an underlying cause of many cardiovascular disorders, and generation of thrombi in the arterial circulation can lead to unstable angina, myocardial infarction, or ischemic stroke. Antithrombotic therapy is widely used, with proven benefit to prevent ischemic stroke and thromboembolic events in patients with atrial fibrillation (AF) or to prevent further ischemic complications in patients with acute coronary syndrome (ACS). Traditional anticoagulants (including unfractionated heparin, low-molecular-weight heparin, and warfarin) and antiplatelet agents (including aspirin, clopidogrel, and prasugrel) are typically used for these indications. Limitations to their use include variable pharmacokinetic and pharmacodynamic profiles, inability to inhibit fibrin-bound thrombin, risk of heparin-induced thrombocytopenia, delayed onset of action, numerous drug interactions, need for substantial laboratory monitoring and dosage titrations, hyporesponsiveness or resistance, hypersensitivity, adverse events, and bleeding. To overcome some of the limitations of traditional agents, new antithrombotic agents under development are highly selective for specific coagulation factors blocking the synthesis of thrombin. Clinicians must have an understanding of the new anticoagulants to aid in the selection of appropriate therapies for patients. We describe the most relevant phases II and III clinical trials that evaluated several recent emerging anticoagulant drugs for use in patients with AF or ACS. The advantages of many new agents include predictable pharmacodynamic response and pharmacokinetic parameters, allowing for fixed oral dosing with no need for laboratory monitoring. For patients with AF, dabigatran is already approved for the prevention of stroke and systemic embolism, rivaroxaban appears to be an effective alternative to warfarin in high-risk patients, and apixaban may also be an effective alternative to aspirin in patients unable to take warfarin. Otamixaban shows promise as an intravenous alternative for patients with ACS in the acute care setting. Likewise, rivaroxaban, dabigatran, and darexaban with or without dual antiplatelet therapy may be beneficial for secondary prevention of ischemic events in patients with ACS.

Original languageEnglish
Pages (from-to)975-1016
Number of pages42
JournalPharmacotherapy
Volume31
Issue number10
DOIs
StatePublished - Oct 2011

Fingerprint

Acute Coronary Syndrome
Anticoagulants
Atrial Fibrillation
Warfarin
Therapeutics
clopidogrel
Stroke
Thrombin
Aspirin
Heparin
Thrombosis
Pharmacokinetics
Phase III Clinical Trials
Phase II Clinical Trials
Blood Coagulation Factors
Fibrinolytic Agents
Low Molecular Weight Heparin
Platelet Aggregation Inhibitors
Unstable Angina
Secondary Prevention

All Science Journal Classification (ASJC) codes

  • Pharmacology (medical)

Cite this

New and emerging anticoagulant therapy for atrial fibrillation and acute coronary syndrome. / Davis, Estella M.; Packard, Kathleen A.; Knezevich, Jon T.; Campbell, Jennifer A.

In: Pharmacotherapy, Vol. 31, No. 10, 10.2011, p. 975-1016.

Research output: Contribution to journalReview article

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