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.
1
,
2
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.
3
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.Abbreviations:
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)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: May 31, 2013
Accepted:
April 11,
2013
Received:
February 1,
2013
Footnotes
DISCLOSURES: J. Desai was supported by a grant from the Digestive Disease Research Foundation. C. Granger received grants from Bristol-Myers Squibb, Pfizer, AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, the Medtronic Foundation, Merck, Sanofi-Aventis, Astellas, and the Medicines Company. He received consulting fees from AstraZeneca, Boehringer Ingelhelm, Bristol-Myers Squibb, GlaxoSmithKline, Hoffmann-LaRoche, Novartis, Otsuka Pharmaceutical, Sanofi-Aventis, Lilly, Pfizer, and the Medicines Company and travel grants from Hoffmann-La Roche, Novartis, and Pfizer. J. Weitz is a consultant for and received honoraria from BMS, Pfizer, Boehringer Ingelhelm, Bayer, Janssen Pharmaceuticals, Daiichi Sankyo, Merck, and Takeda. J. Aisenberg is a consultant for and received honoraria from Boehringer Ingelhelm. No other financial relationships relevant to this publication were disclosed.
See CME section; p. 342.
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Copyright
© 2013 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.
