Oral Antithrombotic Agents for the Prevention of Stroke in Nonvalvular Atrial Fibrillation

Furie, Karen L.; Goldstein, Larry B.; Albers, Gregory W.; Khatri, Pooja; Neyens, Ron; Turakhia, Mintu P.; Turan, Tanya N.; Wood, Kathryn A.

doi:10.1161/str.0b013e318266722a

Cited by 246 publications

(111 citation statements)

References 54 publications

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“…[4][5][6][7][8][9] Therefore, testing the effect of novel therapeutics, such as edoxaban, in this subgroup is relevant to clinical practice. As such, we found that patients with a previous IS/TIA experienced a similar relative, but greater absolute benefit, when compared with patients with no previous IS/TIA, when treated with the oral direct factor Xa inhibitor edoxaban instead of warfarin.…”

Section: Discussionmentioning

confidence: 99%

Outcomes With Edoxaban Versus Warfarin in Patients With Previous Cerebrovascular Events

Rost

Giugliano

Ruff

et al. 2016

Stroke

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T he risk of stroke in patients with atrial fibrillation (AF) is high, 1 and it increases in the presence of other risk factors such as advanced age, congestive heart failure, hypertension, diabetes mellitus, and especially previous ischemic stroke (IS) or transient ischemic attack (TIA). 2 However, even validated risk-stratification scores using these and additional risk factors, such as CHADS 2 (congestive heart failure, hypertension, age ≥75 years, diabetes, previous stroke) and CHA 2 DS 2 -VASc (congestive heart failure, hypertension, age ≥75: 2, diabetes, stroke: 2, vascular disease, sex female) scores 2,3 may underestimate the true risk of stroke recurrence in patients with a previous IS or TIA, 4,5 which might reach as high as 7% to 10% per year. 4,6 Therefore, secondary prevention of stroke in these higher risk patients with AF is a major focus of cerebrovascular care. Background and Purpose-Patients

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Section: Discussionmentioning

confidence: 99%

Outcomes With Edoxaban Versus Warfarin in Patients With Previous Cerebrovascular Events

Rost

Giugliano

Ruff

et al. 2016

Stroke

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“…The main affected area (up to 80%) is the brain -10 to 12% of cerebral infarcts (CI) 4,11 . The frequency increases as age advances: the attributed risk in individuals with 80 years or more reaches 25% 2,5,10,12 . Risk is also greater in women (in all age groups: HR 1.14 [95%CI, 1.07-1.22]: 20.4% of CI in women vs. 15.6% in men) 10,13,14 .…”

Section: Atrial Fibrillation and Stroke Riskmentioning

confidence: 99%

“…It should be remembered however that typical preventive regimens for venous thrombosis exhibit minimal or no efficacy against arterial thromboembolism. The manuscript reviews the vitamin K antagonist Warfarin and the new oral anticoagulants [(NOACs): direct thrombin and factor Xa inhibitors] and is partially based in a number of recently published guidelines from American and European medical societies to which the interested reader is directed for more details 2,3,4,5,6,7,8,9,10 .…”

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confidence: 99%

Preventing bleeding and thromboembolic complications in atrial fibrillation patients undergoing surgery

André

2015

Arq. Neuro-Psiquiatr.

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Neurologists feel uneasy when asked about temporary anticoagulant interruption for surgery in patients with atrial fibrillation (AF). Rational decisions can be made based on current scientific evidence. Method Critical review of international guidelines and selected references pertaining to bleeding and thromboembolism during periods of oral anticoagulant interruption. Results Withholding oral anticoagulants leads to an increased risk of perioperative thromboembolism, depending on factors such as age, renal and liver function, previous ischemic events, heart failure etc. Surgeries are associated with a variable risk of bleeding - from minimal to very high. Individualized decisions about preoperative drug suspension, bridging therapy with heparin and time to restart oral anticoagulants after hemostasis can significantly reduce these opposing risks. Conclusion Rational decisions can be made after discussion with all Health care team professionals involved and consideration of patient fears and expectations. Formal written protocols should help managing antithrombotic treatment during this delicate period.

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“…AHA kılavuzları warfarin (kanıt seviyesi I-A), dabigatran (kanıt seviyesi I-B), rivaroxaban (kanıt seviyesi IIa-B) ve apixaban (kanıt seviyesi I-A) tedavilerine atriyal fibrilasyon tromboemboli riskini önlenmesinde tercih edilebilecek ajanlar olarak belirtmektedir [45,46]. Buna karşın Avrupa kılavuzları yeni nesil oral antikoagülanları warfarine üstün kabül etmektedir (kanıt seviyesi II-A) [15].…”

Section: Yeni Nesil Oral Antikoagülanlara Klinik Yaklaşımunclassified

Atrial fibrillation and stroke in the perspective of new oral anticoagulants

Baş¹,

Topçuoğlu²,

Arsava³

2013

Türk Beyin Damar Hast Derg

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ÖZETAtriyal fibrilasyon (AF) bağımsız, güçlü bir inme risk faktörüdür. Son döneme kadar sadece aspirin ve warfarin AF'lu hastalarda inme profilaksisinde onaylanmış tedavi seçenekleriydi. Warfarinin inmeyi önlemede plaseboya ve aspirine kıyasla gösterilmiş belirgin üstünlüğü olmasına rağmen, kullanım zorlukları yeni tedavi arayışlarını zorunlu kılmıştır. Koagülasyon yolundaki farklı faktörlere etki eden yeni oral antikoagülanlar (dabigatran, apixaban ve rivaroxaban gibi) ile yapılan çalışmalarda bu ilaçların warfarine kıyasla benzer oranda etkili ve güvenli oldukları gösterilmiştir. Yeni oral antikoagülanların hızlı etki başlangıçları, monitorizasyon ihtiyaçlarının olmaması ve düşük ilaç ve gıda etkileşimleri her ne kadar cezbedici olsa da, bu ilaçların henüz özgün antidotlarının olmaması bir dezavantaj oluşturmaktadır. Anahtar Sözcükler: İnme, atriyal fibrilasyon, antikoagülan, dabigatran, apixaban, rivaroxaban, warfarin. ATRIAL FIBRILLATION AND STROKE IN THE PERSPECTIVE OF NEW ORAL ANTICOAGULANTS ABSTRACTAtrial fibrillation is an independent, powerful risk factor for stroke. Until recently, acetyl salicylic acid (aspirin) and warfarin were the only approved treatment options for stroke prophylaxis. Although warfarin provides a significantly better risk reduction in stroke compared to placebo and aspirin, its usage difficulties entailed investigation of new treatment alternatives. Studies showed that new oral anticoagulants (such as dabigatran, apixaban and rivaroxaban) are as efficient and safe as warfarin. New anticoagulants seem appealing by their rapid onset of action and low drug and diet interactions, together with not necessitating any routine monitoring; however lack of specific antidotes constitute a disadvantage at the moment.

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Oral Antithrombotic Agents for the Prevention of Stroke in Nonvalvular Atrial Fibrillation

Cited by 246 publications

References 54 publications

Outcomes With Edoxaban Versus Warfarin in Patients With Previous Cerebrovascular Events

Outcomes With Edoxaban Versus Warfarin in Patients With Previous Cerebrovascular Events

Preventing bleeding and thromboembolic complications in atrial fibrillation patients undergoing surgery

Atrial fibrillation and stroke in the perspective of new oral anticoagulants

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