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New thrombin and factor Xa inhibitors for primary and secondary prevention of ischaemic stroke
- Source :
- CNSneurological disorders drug targets. 12(2)
- Publication Year :
- 2012
-
Abstract
- Atrial fibrillation is a major risk factor for first and recurrent ischaemic stroke, and anticoagulation, mainly by use of coumarin medications, is an effective strategy for reducing ischaemic stroke occurrence in these patients. However, the coumarin medications have disadvantages. Over the past decade, important strides have been made towards developing improved anticoagulant medications. This review discusses these new developments and what they mean for the future of primary and secondary ischaemic stroke prevention in patients with atrial fibrillation. Relevant papers were identified with electronic searches of the Medline and EMBASE databases. Ongoing trials were checked using the Trials Results Centre website. The direct thrombin inhibitors, and the factor Xa inhibitors are the two major new anticoagulant drug classes under development at present. In phase III trials, dabigatran and rivaroxaban demonstrated at least as good performance as warfarin at reducing the rate of ischaemic stroke, systemic embolus, and haemorrhagic ischaemic stroke, whilst maintaining a comparable or lower rate of major bleeding events. Drug level monitoring was not required due to stable pharmacodynamics. AZD0837, apixaban, YM-150, edoxaban and betrixaban all showed promising results in phase II trials, as did S35972 in animal, in vitro and ex vivo models. The future of these new anticoagulants looks encouraging, although there are still some significant challenges to overcome. We need to consider the accumulation of long-term safety and efficacy data, and the development of effective means of reversal of anticoagulation for the direct thrombin inhibitors and factor Xa inhibitors.
- Subjects :
- medicine.medical_specialty
medicine.drug_mechanism_of_action
Databases, Factual
Factor Xa Inhibitor
Dabigatran
Brain Ischemia
chemistry.chemical_compound
Edoxaban
medicine
Animals
Humans
Enzyme Inhibitors
Intensive care medicine
Pharmacology
Rivaroxaban
Clinical Trials as Topic
Anticoagulant drug
business.industry
General Neuroscience
Thrombin
Stroke
chemistry
Anesthesia
Betrixaban
Factor Xa
Apixaban
business
medicine.drug
Discovery and development of direct thrombin inhibitors
Subjects
Details
- ISSN :
- 19963181
- Volume :
- 12
- Issue :
- 2
- Database :
- OpenAIRE
- Journal :
- CNSneurological disorders drug targets
- Accession number :
- edsair.doi.dedup.....690dc96d6dfeebd77409dc06f4c29e37