Straight to the Heart: Pleiotropic Antiarrhythmic Actions of Oral Anticoagulants

Pharmacol Res. 2019 Jul;145:104257. doi: 10.1016/j.phrs.2019.104257. Epub 2019 May 2.


Mechanistic understanding of atrial fibrillation (AF) pathophysiology and the complex bidirectional relationship with thromboembolic risk remains limited. Oral anticoagulation is a mainstay of AF management. An emerging concept is that anticoagulants may themselves have potential pleiotropic disease-modifying effects. We here review the available evidence for hemostasis-independent actions of the oral anticoagulants on electrical and structural remodeling, and the inflammatory component of the vulnerable substrate.

Keywords: Anticoagulants; Atrial fibrillation; Calcium; Protease-activated receptors; Stroke; Thrombin.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Administration, Oral
  • Animals
  • Anti-Arrhythmia Agents / pharmacology
  • Anti-Arrhythmia Agents / therapeutic use*
  • Anticoagulants / pharmacology
  • Anticoagulants / therapeutic use*
  • Atrial Fibrillation / drug therapy*
  • Atrial Fibrillation / metabolism
  • Atrial Fibrillation / physiopathology
  • Factor Xa / metabolism
  • Heart / drug effects
  • Heart / physiology
  • Hemostasis / drug effects
  • Humans
  • Thrombin / metabolism


  • Anti-Arrhythmia Agents
  • Anticoagulants
  • Thrombin
  • Factor Xa