University of Hertfordshire

NOAC in acute coronary syndrome and AF?

Research output: Contribution to journalReview article

  • Maria Niespialowska-Steuden
  • Peter Collins
  • Charis Costopoulos
  • Diana A Gorog
View graph of relations
Original languageEnglish
Number of pages11
Pages (from-to)154-164
JournalCardiovascular & hematological disorders drug targets
Journal publication date2014
Publication statusPublished - 2014


Cardiovascular disease remains a major cause of morbidity and mortality in developed countries. New treatments, in the form of novel oral anticoagulants (NOAC) that reduce thrombotic risk are now available for patients with atrial fibrillation (AF) or acute coronary syndrome (ACS). Warfarin has been the cornerstone of thromboprophylaxis in patients with AF, but treatment is cumbersome, inconvenient and often unreliable, with fluctuating time in therapeutic range. Thrombotic events also continue to occur in a significant number of ACS patients despite antiplatelet therapy. Thus there is an unfilled need to reduce thrombotic events in ACS and AF patients. NOAC comprise direct factor Xa inhibitors (apixaban, rivaroxaban, darexaban, edoxaban), direct thrombin inhibitors (dabigatran) and PAR-1 antagonists (vorapaxar, atopaxar). In this review, we compare and contrast NOACs and review their individual and specific clinical trial database in ACS and AF. In the setting of ACS, the role of NOAC is unclear, as any reduction in ischemic events appears to be offset by hemorrhagic risk. However, NOAC have a definite place in the treatment of patients with non-valvular AF, where they are at least as effective, if not superior to warfarin.


© 2014 Bentham Science Publishers

ID: 13240736