TY - JOUR
T1 - Newer oral anticoagulants
T2 - Stroke prevention and pitfalls
AU - Patel, Anand
AU - Goddeau, Richard P.
AU - Henninger, Nils
N1 - Publisher Copyright:
© Patel et al.; Licensee Bentham Open.
PY - 2016/5/1
Y1 - 2016/5/1
N2 - Warfarin is very effective in preventing stroke in patients with atrial fibrillation. However, its use is limited due to fear of hemorrhagic complications, unpredictable anticoagulant effects related to multiple drug interactions and dietary restrictions, a narrow therapeutic window, frequent difficulty maintaining the anticoagulant effect within a narrow therapeutic window, and the need for inconvenient monitoring. Several newer oral anticoagulants have been approved for primary and secondary prevention of stroke in patients with non-valvular atrial fibrillation. These agents have several advantages relative to warfarin therapy. As a group, these direct oral anticoagulants (DOAC), which include the direct thrombin inhibitor, dabigatran, and the factor Xa inhibitors (rivaroxaban, apixaban, and edoxaban), are more effective than dose adjusted warfarin for prevention of all-cause stroke (including both ischemic and hemorrhagic stroke), and have an overall more favorable safety profile. Nevertheless, an increased risk of gastrointestinal bleeding (with the exception of apixaban), increased risk for thrombotic complication with sudden discontinuation, and inability to accurately assess and reverse anticoagulant effect require consideration prior to therapy initiation, and pose a challenge for decision making in acute stroke therapy.
AB - Warfarin is very effective in preventing stroke in patients with atrial fibrillation. However, its use is limited due to fear of hemorrhagic complications, unpredictable anticoagulant effects related to multiple drug interactions and dietary restrictions, a narrow therapeutic window, frequent difficulty maintaining the anticoagulant effect within a narrow therapeutic window, and the need for inconvenient monitoring. Several newer oral anticoagulants have been approved for primary and secondary prevention of stroke in patients with non-valvular atrial fibrillation. These agents have several advantages relative to warfarin therapy. As a group, these direct oral anticoagulants (DOAC), which include the direct thrombin inhibitor, dabigatran, and the factor Xa inhibitors (rivaroxaban, apixaban, and edoxaban), are more effective than dose adjusted warfarin for prevention of all-cause stroke (including both ischemic and hemorrhagic stroke), and have an overall more favorable safety profile. Nevertheless, an increased risk of gastrointestinal bleeding (with the exception of apixaban), increased risk for thrombotic complication with sudden discontinuation, and inability to accurately assess and reverse anticoagulant effect require consideration prior to therapy initiation, and pose a challenge for decision making in acute stroke therapy.
KW - Atrial fibrillation
KW - Hemorrhage
KW - Ischemic stroke
KW - Oral anticoagulation
KW - Outcome
KW - Review
KW - Therapy
KW - Thrombolysis
UR - http://www.scopus.com/inward/record.url?scp=84980049319&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84980049319&partnerID=8YFLogxK
U2 - 10.2174/1874192401610010094
DO - 10.2174/1874192401610010094
M3 - Article
AN - SCOPUS:84980049319
SN - 1874-1924
VL - 10
SP - 94
EP - 104
JO - Open Cardiovascular Medicine Journal
JF - Open Cardiovascular Medicine Journal
ER -