Clinical Question: Is ximelagatran ...

Clinical Question: Is ximelagatran effective for attack prevention in patients with nonvalvular atrial fibrillation?

Setting: Outpatient (any)

application of mind Design: Randomized controlled trial (double-blinded)

Allocation: Concealed

Synopsis: Ximelagatran furnishs fixed oral dosing without the ne for coagulation monitoring in the prevention of knock in patients with nonvalvular atrial fibrillation. Investigators recorded 3,922 patients with nonvalvular atrial fibrillation and additional established hit risk factors. Eligible patients were randomized to treatment with ximelagatran in a dosage of 36 mg twice daily or warfarin adjusted to an International Normalized Ratio of 20 to 30 someones assessing outcomes were blinded to treatment cluster assignment. All enrolled patients were followed for a mean of 20 months

Using intention-to-treat analysis, returning stroke events occurred with equal oftenness in the ximelagatran and warfarin treatment assign places tos (1.6 versus 1.2 percent by year, respectively). Major bleeding conclusions and all-cause mortality were similar between the sum of two units treatment groups. Elevated serum alanine transaminase flushs were three times greater than normal in 6 percent of patients in the ximelagatran group--almost all replyed to normal regardless of whether treatment was continued. single case of fatal liver disease was documented. The reflection was 90 percent powered to lay open a 2 percent difference in misfortune prevention rates between the sum of two units treatment groups. Another article in the same journal (O'Brien CL Gage BF costlinesss and effectiveness of ximelagatran for visitation prophylaxis in chronic atrial fibrillation. JAMA 2005;293:699-706) reported that ximelagatran is unlikely to be cost-effective in patients with atrial fibrillation unles they already have a high risk of intracranial hemorrhage or an established grave quality of life with warfarin.

Bottom Line: Fixed-dose ximelagatran appears to be as effective as warfarin for thump prevention in patients with nonvalvular atrial fibrillation. interests about cost effectiveness, the potential for increasing the risk of myocardial ischemia, and the rare if it were not that potentially serious risk of liver toxicity should limit its use to patients intolerant to warfarin or who are at a high risk of intracranial hemorrhage. (Level of Evidence: 1b)

application of mind Reference: Albers GW, et al. Ximelagatran v warfarin for affliction prevention in patients with nonvalvular atrial fibrillation: a randomized trial. JAMA February 9 2005;293:690-8

Used with permission from Slawson D Ximelagatran effective for rap prevention with nonvalvular trial fibrillation. Accessed online March 31 2005 at: http://www InfoPOEMs.com.

COPYRIGHT 2005 American Academy of Family Physicians

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