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Reservations against new oral anticoagulants after stroke and cerebral bleeding

Claudia Stöllberger1, Josef Finsterer

  • 1Krankenanstalt Rudolfstiftung, Juchgasse 25, A-1030 Wien, Austria. claudia.stollberger@chello.at

Journal of the Neurological Sciences
|May 1, 2013
PubMed

Insights

New oral anticoagulants (NOAC) show similar efficacy to warfarin for atrial fibrillation patients. However, caution is advised for stroke patients due to trial exclusions and unknown long-term effects.

Area of Science:

  • Pharmacology
  • Cardiology
  • Neurology

Background:

  • New oral anticoagulants (NOACs) like dabigatran, rivaroxaban, and apixaban are used for stroke prevention in atrial fibrillation (AF).
  • Clinical trials indicate NOACs have comparable efficacy and safety to warfarin.

Purpose of the Study:

  • To evaluate the cautious use of NOACs in patients with stroke or cerebral hemorrhage.
  • To highlight limitations and unknowns regarding NOACs in specific patient populations.

Main Methods:

  • Review of clinical trial data for NOACs in AF patients.
  • Analysis of exclusion criteria and safety profiles in NOAC trials.

Main Results:

  • Patients with prior stroke or cerebral bleeding were excluded from key NOAC trials.
  • Lack of antidotes, reliable monitoring, and unknown drug-drug interactions pose challenges.
  • Long-term effects of NOACs on infections, malignancies, and dementia remain uninvestigated.

Conclusions:

  • Caution is recommended when using NOACs in patients with a history of stroke or cerebral hemorrhage.
  • Further post-marketing surveillance and comparative studies are necessary to fully understand NOACs' role in stroke prevention.

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