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Assessment of Advantages and Disadvantages of Agents Used For Therapeutic Anticoagulation

Warfarin is an awful drug. That is not to say that it is not also a lifesaving drug—it is. So many randomized controlled trials have demonstrated warfarin's remarkable ability to reduce embolic stroke in patients with atrial fibrillation, the indication for warfarin that this article focuses on, that it would be unethical to perform another placebo-controlled warfarin trial in patients with atrial fibrillation who are able to tolerate the drug ( Table 1 ). 1-6 However, its numerous and profound limitations include a narrow therapeutic range, requiring patients to have at least monthly monitoring, a highly variable bioavailability between individuals, an enormous number of both drug–drug and diet–drug interactions, and the existence of common genetic polymorphisms that influence drug effect, leading many to wonder whether the Food and Drug Administration (FDA) would approve warfarin if it came to review in the current climate. Currently there are more than a dozen anticoagulant drugs under development in an attempt to replace warfarin for the prevention of stroke and systemic embolism in patients with atrial fibrillation; two of them, dabigatran and rivaroxaban, have been approved. Some of these anticoagulants, like dabigatran, are thrombin (Factor II) inhibitors; others, like rivaroxaban, apixaban, and http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Disease-a-Month Elsevier
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