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Non-vitamin-K oral anticoagulants (NOACs) for the prevention of secondary stroke

Hans-Christoph Diener1, George Ntaios2, Martin O'Donnell3

  • 1a Department of Neurology , University Hospital Essen , Essen , Germany.

Expert Opinion on Pharmacotherapy
|August 29, 2018
PubMed
Abstract

Insights

Non-vitamin K oral anticoagulants (NOACs) offer superior stroke prevention for atrial fibrillation (AF) patients compared to warfarin. These novel anticoagulants significantly reduce stroke risk and bleeding, enhancing patient outcomes.

Area of Science:

  • Cardiology
  • Neurology
  • Pharmacology

Background:

  • Oral anticoagulation with vitamin K antagonists (VKA) is effective for stroke prevention in atrial fibrillation (AF).
  • VKAs have limitations, leading to the development of non-vitamin K oral anticoagulants (NOACs).

Purpose of the Study:

  • To review randomized trial results for four NOACs (apixaban, dabigatran, edoxaban, rivaroxaban).
  • To discuss NOAC efficacy and safety in patients with prior transient ischemic attacks or ischemic stroke.

Main Methods:

  • Analysis of published data from major randomized trials (ARISTOTLE, RE-LY, ENGAGE, ROCKET-AF).
  • Focus on subgroup analyses of patients with a history of stroke or TIA.

Main Results:

  • NOACs demonstrate superiority over warfarin for secondary stroke prevention in AF patients.
  • NOACs result in a 50% reduction in intracerebral hemorrhage compared to VKAs.
  • Apixaban showed superiority over aspirin in the AVERROES trial with comparable bleeding rates.

Conclusions:

  • NOACs provide an improved therapeutic option for secondary stroke prevention in AF.
  • NOACs offer advantages over warfarin, including a better bleeding profile and ease of use.
  • Aspirin is no longer recommended for secondary stroke prevention in AF patients.
Keywords:
Atrial fibrillationTIAapixabanaspirindabigatranedoxabanrivaroxabansecondary stroke preventionstrokewarfarin

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