Newer antithrombotics in atrial fibrillation

Newer antithrombotics in atrial fibrillation

Why do we need newer antithrombotics in atrial fibrillation? It is well known that long term anticoagulation reduces the incidence of stroke in nonvalvular atrial fibrillation. Vitamin K antagonists like warfarin are highly effective for long term anticoagulation and stroke prevention. But they have numerous limitations including erratic control and drug interactions which are challenging for physicians and patients. Hence the search for newer antithrombotics for stroke prevention in atrial fibrillation.
Newer antithrombotics in atrial fibrillation include the direct thrombin inhibitor dabigatran, direct factor Xa inhibitors like rivaroxaban, apixaban and edoxaban as well as the vitamin K analogue tecarfarin. Otamixaban is a potential intravenous alternative for the acute care setting. In general, direct thrombin and factor Xa inhibitors are small, synthetic molecules with Predictable pharmacokinetics and pharmacodynamic effect, having few drug interactions and do not require routine therapeutic drug monitoring.