Review article| Volume 78, ISSUE 2, P227-239, August 2013

Novel oral anticoagulants in gastroenterology practice

      Atrial fibrillation (AF), the most common sustained cardiac arrhythmia, is associated with a 5-fold increase in the risk of ischemic stroke, and AF-related strokes have worse outcomes than those not associated with AF.
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      Probability of stroke: a risk profile from the Framingham Study.
      Warfarin reduces the risk of stroke in patients with AF by approximately two-thirds and is more effective than aspirin or dual antiplatelet therapy with aspirin and clopidogrel.
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      • Benavente O.
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      Although effective, warfarin has limitations that complicate its use. These include unpredictable pharmacokinetics and pharmacodynamics related to genetic polymorphisms and to variations in dietary vitamin K intake and numerous drug-drug interactions. Therefore, frequent monitoring is needed to attempt to keep the international normalized ratio (INR) within the therapeutic range. Such monitoring is inconvenient for patients and physicians and costly for the healthcare system. The limitations of warfarin contribute to its underuse in eligible patients with AF, and even when warfarin is given, the INR is frequently outside the therapeutic range.


      AF (atrial fibrillation), aPTT (activated partial thromboplastin time), ARISTOTLE (apixaban for reduction in stroke and thromboembolic events in atrial fibrillation), ASGE (American Society for Gastrointestinal Endoscopy), INR (international normalized ratio), NOAC (novel oral anticoagulant), NSAID (nonsteroidal anti-inflammatory drug), PCC (prothrombin complex concentrate), PPI (proton pump inhibitor), PT (prothrombin time), RE-LY (randomized evaluation of long term anticoagulant therapy), ROCKET-AF (rivaroxaban once daily oral direct factor Xa inhibition compared with vitamin K antagonism for prevention of stroke and embolism trial in atrial fibrillation), RR (relative risk)
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