Stroke Prevention with Oral Anticoagulants: Summary of the Evidence and Efficacy Measures as an Aid to Treatment Choices

Cardiology and Therapy
José Francisco Kerr Saraiva

Abstract

Atrial fibrillation (AF) is an established risk factor for a first or recurrent stroke. Despite proven efficacy in preventing stroke in patients with AF, warfarin is underused, partly due to safety concerns. Recent randomized trials have shown that non-vitamin K antagonist oral anticoagulants (NOACs) such as dabigatran (a direct thrombin inhibitor) and apixaban, edoxaban, and rivaroxaban (factor Xa inhibitors) are not only non-inferior or superior to warfarin but also demonstrate a decreased risk of cerebrovascular bleeding among patients with AF and moderate to high risk of stroke. Additionally, NOACs have an advantage of requiring no monitoring of the international normalized ratio compared with warfarin. This review summarizes the published literature on NOACs for the primary and secondary prevention of ischemic strokes, with an emphasis on the expected absolute benefits from the introduction of such agents. As compared with warfarin, NOACs significantly reduce the risk of hemorrhagic stroke, and only dabigatran (150 mg twice daily) was found to significantly reduce the risk of ischemic stroke. However, measures of relative benefits from medical interventions do not immediately provide the estimated benefit to be derived fro...Continue Reading

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Citations

Nov 8, 2019·International Journal of Nursing Knowledge·Shuxiao HouShaomei Shang
Sep 9, 2020·Journal of Medical Economics·Dejan MilentijevicPatrick Lefebvre
Jun 10, 2021·Methodist DeBakey Cardiovascular Journal·Randall K Wolf
Aug 12, 2021·Journal of Comparative Effectiveness Research·François LalibertéJeffrey S Berger

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