Ximelagatran vs. Warfarin for Atrial Fibrillation

Ximelagatran's viability for this indication might come down to the degree of liver-function monitoring that the drug requires.

Ximelagatran is an oral direct thrombin inhibitor that does not require coagulation monitoring. The drug compares favorably with warfarin for preventing venous thrombosis after knee surgery (Journal Watch Nov 7 2003) and reduces the rate of recurrent ischemia after myocardial infarction (Journal Watch Nov 7 2003).

Now, researchers have conducted an international, manufacturer-sponsored, open-label, randomized trial in which 3410 patients with nonvalvular atrial fibrillation received ximelagatran (36 mg twice daily) or warfarin (therapeutic target INR, 2.0-3.0). All patients had at least 1 of these stroke risk factors: hypertension, age ≥75, previous stroke or transient ischemic attack, left-ventricular dysfunction, or age ≥65 with diabetes o…

Reviewing Author

Allan S. Brett, MD