Stroke prevention in atrial fibrillation: another step sideways.

摘要

In today's Lancet, the Amadeus Investigators report their open-label, randomised, non-inferiority trial in which they examined whether idraparinux, a long-acting indirect inhibitor of factor Xa, was non-inferior to oral vitamin K antagonists for thromboembolism prevention in nearly 5000 patients with atrial fibrillation.1 Disappointingly, the trial was stopped early because of excessive major bleeding in those receiving idraparinux. Patients who were older, had reduced kidney function, or wer.e concurrently using aspirin were at greatest risk of bleeding. Amadeus is part of a remarkable wave of very large trials of new anticoagulants for atrial fibrillation which are investigating replacements for vitamin K antagonists (especially warfarin) with agents that are comparably effective but less likely to cause bleeding and easier to use/and manage. To date, this goal has proved elusive.