Secondary prevention in non-valvular atrial fibrillation patients: a practical approach with edoxaban

Abstract

Patients with atrial fibrillation and prior stroke or transient ischemic attack exhibit a very high risk of recurrence. Secondary prevention with oral anticoagulants is mandatory. Overall, clinical guidelines recommend the use of target-specific oral anticoagulants over vitamin K antagonists for secondary prevention of stroke in patients with atrial fibrillation. However, many patients with atrial fibrillation and previous stroke are not receiving the appropriate antithrombotic treatment, perhaps due to the perceived risks of anticoagulation including the risk of hemorrhagic transformation of an ischemic stroke. The ENGAGE AF-TIMI 48 trial showed that although edoxaban 60 mg and warfarin reduced the risk of stroke to a similar extent, edoxaban exhibited a lesser risk of bleeding, particularly intracranial hemorrhage. Importantly, these data were independent of the presence of prior stroke or transient ischemic attack. Therefore, edoxaban can be used in both primary and secondary prevention of stroke in patients with non-valvular atrial fibrillation. The aim of this review was to update the available evidence about edoxaban in the clinical management of secondary prevention in individuals with non-valvular atrial fibrillation.

Frequency, Severity, Risk Factors, and Outcome of Hemorrhagic Transformation in Anterior and Posterior Stroke

“…VKAs are widely known for their association with an increased risk of bleeding events, including hemorrhagic strokes [25][26][27]. However, there are few studies that have investigated this question and clearly indicate that prior VKA use increases the risk of HT in the event of AIS [28]. Consistent with these data, prior use of VKAs increased the risk of HT by more than fourfold, an association that was statistically significant.…”

State of play and future direction with NOACs: An expert consensus

“…a lower rate of bleeding compared to warfarin for primary and secondary stroke prevention (74). Therefore, NOACs are recommended for use in patients with or without previous history of stroke/TIA.…”