Myocardial Infarction and Novel Oral Anticoagulants
Factor II vs Factor Xa inhibition: Is There a Difference?
Patients who are at risk of thromboembolic disorders may also be at risk of myocardial infarction (MI). This is because shared risk factors such as hypertension, diabetes, and advancing age may predispose them to both conditions, and the pathogenesis of MI results from thrombus formation following the rupture of an atherosclerotic plaque in a coronary artery.1
Appropriate antithrombotic and anticoagulant treatment can prevent the development of thrombosis and thus potentially reduce the likelihood of MI. Data suggest that treatment with the vitamin K antagonist (VKA) warfarin might actually
be protective against the development of cardiovascular events in patients who have already had a heart attack.2-4 The mechanism responsible for this cardioprotective effect is explained by the fact that the pathophysiology of MI involves both platelets and the coagulation system, the latter being the target of warfarin.3
Recently, novel oral anticoagulants have been introduced to the market, which have the potential to overcome many of the barriers that currently limit VKA anticoagulation therapy. Oral thrombin (Factor II) inhibitors, however, have been linked to an increased number of cases of MI ►