What is the role of the new anticoagulants (dabigatran, rivaroxaban, apixaban)?
New oral anticoagulants include the direct thrombin inhibitor dabigatran and the factor Xa inhibitors apixaban and rivaroxaban.
The benefit of these agents over warfarin is due to better stroke prevention as well as lower bleeding risk. Intracerebral hemorrhage, the most dreaded complication of anticoagulation, was substantially reduced.
Dabigatran and rivaroxaban had higher rates of GI bleeding than warfarin; apixaban showed no such trend.
Dabigatran showed a small but consistent increase in myocardial infarction, although it decreased overall vascular events and mortality.
One disadvantage is a higher risk of thrombotic events when these agents are stopped, so patients must be extremely compliant.
Significant renal impairment is a contraindication.
