Treatment strategies in patients with
atrial fibrillation typically involve pharmacologic or interventional invasive
therapies to suppress the rhythm, control ventricular contraction rates, or prevent thromboembolic complications. Current
therapies used for rhythm conversion in
atrial fibrillation may have undesirable risks or side effects that limit this approach. Lifelong anticoagulation may be necessary to prevent the formation of
thrombus in the left atrial chamber that can travel into the cerebral circulation to cause a
stroke. Currently,
warfarin is the most commonly prescribed
anticoagulant for this purpose. Unfortunately, many patients with
atrial fibrillation may not receive
warfarin because of the difficulties in dosing and maintaining desirable target goals. The oral
direct thrombin inhibitor ximelagatran has several pharmacologic properties that provide a unique and potentially desirable treatment option. Clinical studies have demonstrated that
ximelagatran, administered in twice-daily doses of 36 mg, is non-inferior to
warfarin for thromboprophylaxis against
stroke or systemic
embolism in
atrial fibrillation. The pharmacology of
ximelagatran and clinical trials with its use in
atrial fibrillation is reviewed.