Newer Oral Anticoagulants: Stroke Prevention and Pitfalls

被引:5
|
作者
Patel, Anand [1 ]
Goddeau, Richard P., Jr. [1 ]
Henninger, Nils [1 ,2 ]
机构
[1] Univ Massachusetts, Sch Med, Dept Neurol, 55 Lake Ave North, Worcester, MA 01655 USA
[2] Univ Massachusetts, Sch Med, Dept Psychiat, Worcester, MA 01655 USA
来源
OPEN CARDIOVASCULAR MEDICINE JOURNAL | 2016年 / 10卷
关键词
Atrial fibrillation; hemorrhage; ischemic stroke; oral anticoagulation; outcome; review; therapy; thrombolysis;
D O I
10.2174/1874192401610010094
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
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.
引用
收藏
页码:94 / 104
页数:11
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