New Oral Anticoagulants in Atrial Fibrillation Forever?

Abstract

Atrial fibrillation is the most common chronic cardiac arrhythmia in clinical cardiology. It affects ≈1% of the population, and, of individuals >80 years of age, ≈10% have this rhythm disturbance. Owing to the loss of the atrial contribution to ventricular filling, left ventricular function is diminished resulting in a propensity to heart failure, fatigue, and disability. Furthermore, the sensation of palpations can be very disturbing for younger patients and may hamper them in their physical and professional activities. Finally, the diminished blood flow through the heart, especially the left atrium, may lead to thrombosis in the left atrium and the left atrial appendage, resulting in systemic embolization. Although many of the characteristic risks and consequences of atrial fibrillation have been known for several decades, little progress has been made in the management of the disease until the past 10 years. Correction of the heart rhythm either pharmacologically or by electrocardioversion has not improved clinical outcome.1–3 Pharmacological management of atrial fibrillation can be helpful in slowing the heart rate, but restoring sinus rhythm is rarely successful over time and may even be deleterious.1,2 The prevention of thromboembolism and stroke can be achieved by the use of oral anticoagulation with vitamin K antagonists. Although this is very successful,4 the therapy is laborious and is associated with severe bleeding in up to 3% of patients per year.5 New oral anticoagulants have recently been developed, tested, and introduced in clinical practice. They are at least as effective as warfarin, and are …