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Although warfarin prevents ischemic stroke in patients with nonvalvular atrial fibrillation (NVAF), its safety and efficacy are limited considerably by the potential for over- and underdosing, despite frequent monitoring and adjustment. The oral direct thrombin inhibitor (DTI) ximelagatran has shown great promise as a safe alternative to warfarin in these patients (Journal Watch Cardiology Jul 18 2003).
In a manufacturer-sponsored, multinational, open-label trial, 3410 patients (mean age, 70) with NVAF and at least 1 stroke risk factor were randomized to dose-adjusted warfarin (target INR, 2.0-3.0) or ximelagatran (36 mg twice daily). The 2 groups had similar baseline characteristics. However, significantly more ximelagatran than warfarin re…