Ximelagatran effective in stroke prevention

Implications:    Ximalagatran is comparable to coumadin in stroke prevention.  In this analysis of 7000 patients with atrial fibrillation, the stroke rate was less with ximelagatran than with coumadin with a similar bleeding profile.  The combination of aspirin and coumadin did not improve the stroke rate but it tripled the bleeding complication rate.  Ximelagatran was withdrawn from the market for liver toxicity problems, not for lack of efficacy. It is unlikely to be resurrected for a narrow niche market such as this.  This study is important because it shows the utility of oral direct thrombin inhibitors once one is developed that doesn't cause liver toxicity.

Analysis:  
 The URL for this article is:

 http://www.medscape.com/viewarticle/553506 

 This article is unlikely to have a great impact on Coumadin use.

 It will not impact AstraZeneca's market significantly since ximelagatran was withdrawn for liver toxicity problems, not lack of efficacy.

 This is another study showing the utility of oral direct thrombin inhibitors and will bolster the portfolio of the agent with these properties that does not cause liver toxicity.

 Agents in the pipeline with these properties hold great promise.