Abstract:
:Until recently, vitamin K antagonists were the only available oral anticoagulants, but with numerous limitations that prompted the introduction of new oral anticoagulants targeting the single coagulation enzymes thrombin (dabigatran) or factor Xa (apixaban, rivaroxaban, and edoxaban) and given in fixed doses without coagulation monitoring. Here we review the pharmacology and the results of clinical trials with these new agents in stroke prevention in atrial fibrillation and secondary prevention after acute coronary syndromes, providing perspectives on their future incorporation into clinical practice. In phase III trials in atrial fibrillation, compared with warfarin, dabigatran etexilate 150 mg B.I.D. reduced the rates of stroke/systemic embolism without any difference in major bleeding; dabigatran etexilate 110 mg B.I.D. had similar efficacy with decreased bleeding; apixaban 5 mg B.I.D. reduced stroke, systemic embolism, and mortality as well as major bleeding; and rivaroxaban 20 mg Q.D. was noninferior to warfarin for stroke and systemic embolism without a difference in major bleeding. All these agents reduced intracranial hemorrhage. Edoxaban is currently being evaluated in a further large phase III trial. Apixaban and rivaroxaban were evaluated in phase III trials for prevention of recurrent ischemia in patients with acute coronary syndromes who were mostly receiving dual antiplatelet therapy, with conflicting results on efficacy but consistent results for increased major bleeding. Overall, the new oral anticoagulants are poised to replace vitamin K antagonists for many patients with atrial fibrillation and may have a role after acute coronary syndromes. Although convenient to administer and manage, they present challenges that need to be addressed.
journal_name
J Am Coll Cardioljournal_title
Journal of the American College of Cardiologyauthors
De Caterina R,Husted S,Wallentin L,Andreotti F,Arnesen H,Bachmann F,Baigent C,Huber K,Jespersen J,Kristensen SD,Lip GY,Morais J,Rasmussen LH,Siegbahn A,Verheugt FW,Weitz JI,Coordinating Committee.doi
10.1016/j.jacc.2012.02.008subject
Has Abstractpub_date
2012-04-17 00:00:00pages
1413-25issue
16eissn
0735-1097issn
1558-3597pii
S0735-1097(12)00503-7journal_volume
59pub_type
杂志文章,评审abstract::The efficacy and safety of intravenous propafenone was studied in 10 patients with Wolff-Parkinson-White syndrome and in 2 patients with a concealed accessory pathway. During electrophysiologic study, the effect of propafenone on the effective refractory period of the accessory pathway was determined, as well as its e...
journal_title:Journal of the American College of Cardiology
pub_type: 临床试验,杂志文章
doi:10.1016/s0735-1097(87)80478-3
更新日期:1987-06-01 00:00:00
abstract:OBJECTIVES:The purpose of this study was to determine whether the induction at electrophysiologic study of sustained monomorphic ventricular tachycardias with multiple QRS complex configurations predicted failure of subsequent serial electrophysiologic study guided antiarrhythmic drug testing. BACKGROUND:Ventricular t...
journal_title:Journal of the American College of Cardiology
pub_type: 临床试验,杂志文章
doi:10.1016/0735-1097(93)90425-z
更新日期:1993-10-01 00:00:00
abstract:OBJECTIVES:We conducted a randomized, blinded, controlled study evaluating the impact of anterior fat pad (AFP) maintenance on postoperative atrial fibrillation (POAF) incidence. BACKGROUND:Drugs with antiadrenergic effects reduce POAF. Because the epicardial AFP is parasympathetically innervated, its routine excision...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.jacc.2006.10.033
更新日期:2007-01-23 00:00:00
abstract::Syncope in apparently normal patients has been attributed to an inhibitory reflex originating in cardiac sensory receptors. The reflex may be elicited by upright tilt with or without isoproterenol infusion. In this study, an upright 90 degree tilt protocol was evaluated in 20 young patients aged 7 to 22 years with syn...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/0735-1097(90)90474-4
更新日期:1990-07-01 00:00:00
abstract:OBJECTIVES:We sought to characterize the predictors of incident congestive heart failure (CHF), as determined by central adjudication, in a community-based elderly population. BACKGROUND:The elderly constitute a growing proportion of patients admitted to the hospital with CHF, and CHF is a leading source of morbidity ...
journal_title:Journal of the American College of Cardiology
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doi:10.1016/s0735-1097(00)00582-9
更新日期:2000-05-01 00:00:00
abstract:OBJECTIVES:We sought to determine the prevalence of treatable left ventricular (LV) systolic dysfunction (LVSD) in patients who present with their first noncardiac vascular episode. BACKGROUND:Screening for LV dysfunction in patients who present with their first stroke (cerebrovascular accident), their first transient...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/s0735-1097(01)01725-9
更新日期:2002-01-16 00:00:00
abstract:OBJECTIVES:The purpose of this research was to find out whether, in humans, dobutamine-induced hemodynamic effects and increase in plasma-renin activity (PRA) might be beta1-adrenoceptor (beta1AR) genotype-dependent. BACKGROUND:In vitro Arg389Gly-beta1AR polymorphism exhibits decreased receptor signaling. METHODS:We ...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/j.jacc.2005.08.041
更新日期:2005-12-06 00:00:00
abstract::Despite the numerous documented benefits of cardiac resynchronization therapy (CRT), a significant proportion of patients undergoing CRT do not demonstrate symptomatic or morphologic improvement, triggering the search to improve targeting of this therapy. Many studies now support direct assessment of mechanical dyssyn...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章,评审
doi:10.1016/j.jacc.2005.09.015
更新日期:2005-12-20 00:00:00
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journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章,评审
doi:10.1016/0735-1097(93)90468-g
更新日期:1993-10-01 00:00:00
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journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/j.jacc.2013.04.073
更新日期:2013-09-24 00:00:00
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journal_title:Journal of the American College of Cardiology
pub_type: 临床试验,杂志文章
doi:10.1016/j.jacc.2007.08.016
更新日期:2007-11-20 00:00:00
abstract:OBJECTIVES:The study aimed to evaluate inclacumab for the reduction of myocardial damage during a percutaneous coronary intervention (PCI) in patients with non-ST-segment elevation myocardial infarction. BACKGROUND:P-selectin is an adhesion molecule involved in interactions between endothelial cells, platelets, and le...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1016/j.jacc.2013.03.003
更新日期:2013-05-21 00:00:00
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journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/s0735-1097(99)00165-5
更新日期:1999-07-01 00:00:00
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journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.jacc.2009.03.066
更新日期:2009-08-04 00:00:00
abstract::The effectiveness of an intermittent regimen of transdermal nitroglycerin in chronic stable angina was evaluated in 206 patients using serial treadmill testing. After a placebo stabilization phase, patients were randomized to 4 weeks of double-blind treatment with transdermal nitroglycerin, 10 or 20 cm2 (equivalent to...
journal_title:Journal of the American College of Cardiology
pub_type: 临床试验,杂志文章,多中心研究,随机对照试验
doi:10.1016/0735-1097(89)90216-7
更新日期:1989-03-15 00:00:00
abstract:OBJECTIVES:We explored whether vascular protection by carvedilol could contribute to its superior effects in the treatment of heart failure (HF) compared with metoprolol tartrate in the COMET (Carvedilol Or Metoprolol European Trial) study. BACKGROUND:Full adrenergic blockade by carvedilol and additional (e.g., antiox...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.jacc.2006.10.059
更新日期:2007-03-06 00:00:00
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journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/s0735-1097(01)01692-8
更新日期:2002-01-02 00:00:00
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journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
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journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/j.jacc.2005.09.041
更新日期:2006-02-07 00:00:00
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pub_type: 杂志文章
doi:10.1016/j.jacc.2005.06.058
更新日期:2005-10-04 00:00:00
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journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章,评审
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更新日期:2017-08-01 00:00:00
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journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/j.jacc.2011.05.018
更新日期:2011-08-16 00:00:00
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journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/j.jacc.2015.01.045
更新日期:2015-04-14 00:00:00
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journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/j.jacc.2012.12.018
更新日期:2013-03-05 00:00:00
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journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/j.jacc.2013.07.099
更新日期:2013-12-10 00:00:00
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journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/s0735-1097(00)00772-5
更新日期:2000-09-01 00:00:00
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journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/0735-1097(91)90703-c
更新日期:1991-01-01 00:00:00
abstract:OBJECTIVES:The goal of this study was to assess whether selectin blockade reduces myocardial platelet deposition and platelet-mediated injury after transient ischemia. BACKGROUND:Selectins participate in platelet adhesion to reperfused endothelium. METHODS:Thiopental-anesthetized, open-chest pigs were subjected to me...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/j.jacc.2004.09.068
更新日期:2005-01-18 00:00:00
abstract:OBJECTIVES:The objective of this study was to evaluate endothelium-dependent vasodilation and carotid intimal-medial thickness (IMT) in children with insulin-dependent diabetes mellitus. BACKGROUND:Diabetes mellitus is an established risk factor for atherosclerosis. Vascular complications of diabetes are not clinicall...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/s0735-1097(02)02894-2
更新日期:2003-02-19 00:00:00
abstract:BACKGROUND:Data conflict regarding the relative effectiveness of carotid artery stenting (CAS) and carotid artery endarterectomy (CEA) for the prevention of stroke due to carotid artery stenosis. OBJECTIVES:The authors performed an updated meta-analysis evaluating the efficacy and safety of CAS versus CEA, given recen...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章,meta分析
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更新日期:2017-05-09 00:00:00