New Oral Anticoagulants in Atrial Fibrillation Forever?
Atrial fibrillation is the most common chronic cardiac arrhythmia in clinical cardiology. It affects about 1% of the population, and of individuals over the age of 80 about 10% have this rhythm disturbance. Due 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 embolisation. Although many of the characteristic risks and consequences of atrial fibrillation are known for several decades, little progress has been made in the management of the disease until the last 10 years. Correction of the heart rhythm either pharmacologically or by electrocardioversion has not improved clinical outcome1-3. 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 deleterious1,2. Prevention of thromboembolism and stroke can be achieved by the use of oral anticoagulation with vitamin K antagonists. Although this is very successful4, the therapy is laborious and is associated with severe bleeding in up to 3% of patients per year5. Recently, new oral anticoagulants have been developed, tested and introduced in clinical practice. They are at least as effective as warfarin, and are safer, especially with respect to the occurrence of intracranial bleeding6. However, long-term data on efficacy and safety of this new treatment strategy are lacking.
- Received May 26, 2013.
- Accepted May 29, 2013.