Andrew Wassef1, Ken Butcher2. 1. Division of Neurology, Department of Medicine, University of Alberta, Edmonton, Canada Division of General Internal Medicine, Department of Medicine, University of Alberta, Edmonton, Canada. 2. Division of Neurology, Department of Medicine, University of Alberta, Edmonton, Canada ken.butcher@ualberta.ca.
Abstract
BACKGROUND: Four nonvitamin K antagonist oral anticoagulants (NOACs) are approved for stroke prevention in patients with nonvalvular atrial fibrillation (NVAF). AIMS: In this review, we assemble available evidence for the best management of ischemic and hemorrhagic stroke patients in the context of NOAC use. SUMMARY OF REVIEW: NOACs provide predictable anticoagulation with fixed dosages. The direct thrombin inhibitor dabigatran and direct factor Xa inhibitors apixaban, edoxaban, and rivaroxaban are all noninferior to warfarin for the prevention of ischemic stroke and systemic embolism and are associated with reduced incidence of intracranial hemorrhage. While these agents offer treatment options for NVAF patients, they also present challenges specific to the clinician managing cerebrovascular disease patients. CONCLUSIONS: We summarize available evidence and current approaches to the initiation, dosing, monitoring and potential reversal of NOACs in stroke patients.
BACKGROUND: Four nonvitamin K antagonist oral anticoagulants (NOACs) are approved for stroke prevention in patients with nonvalvular atrial fibrillation (NVAF). AIMS: In this review, we assemble available evidence for the best management of ischemic and hemorrhagic strokepatients in the context of NOAC use. SUMMARY OF REVIEW: NOACs provide predictable anticoagulation with fixed dosages. The direct thrombin inhibitor dabigatran and direct factor Xa inhibitors apixaban, edoxaban, and rivaroxaban are all noninferior to warfarin for the prevention of ischemic stroke and systemic embolism and are associated with reduced incidence of intracranial hemorrhage. While these agents offer treatment options for NVAF patients, they also present challenges specific to the clinician managing cerebrovascular diseasepatients. CONCLUSIONS: We summarize available evidence and current approaches to the initiation, dosing, monitoring and potential reversal of NOACs in strokepatients.