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Informing the Choice of Direct Oral Anticoagulant Therapy in Patients With Atrial Fibrillation
Anticoagulation is the fundamental priority for the prevention of stroke in patients with atrial fibrillation, yet enthusiasm for use among patients at highest thromboembolic risk is often tempered by concern for increased bleeding. In one of the earliest studies evaluating vitamin K antagonists (VKA) in atrial fibrillation, Askey and Cherry noted in 1950 that anticoagulant use for thromboembolic prophylaxis requires “a reasonable assurance that the benefit will justify the bother and expense of control and the dangers of the drug,” and predicted that “safer anticoagulant drugs will be available eventually.” It wou...
Source: JAMA - December 21, 2021 Category: General Medicine Source Type: research

How Effective and Safe Is Factor XI Inhibition in Preventing Venous Thrombosis?
The introduction of the direct oral anticoagulants for stroke prevention in atrial fibrillation and the management of thromboembolism has transformed the care of patients with these disorders. These drugs, which selectively and reversibly inhibit factor Xa or thrombin in the common pathway of the coagulation cascade, have a wide therapeutic window; this allows for simplified dosing regimens without laboratory monitoring of most adult patients as contrasted to vitamin K antagonists. This class of drug is also associated with a lower bleeding risk than vitamin K antagonists, which has been most clearly demonstrated by a 50% ...
Source: JAMA - January 14, 2020 Category: General Medicine Source Type: research