Choosing a particular oral anticoagulant and dose for stroke prevention in individual patients with non-valvular atrial fibrillation: part 1
File(s)
Accepted version
Author(s)
Type
Journal Article
Abstract
Patients with atrial fibrillation (AF) have a high risk of stroke and mortality, which can be considerably reduced by oral anticoagulants (OAC). Recently, four non-vitamin-K oral anticoagulants (NOACs) were compared with warfarin in large randomized trials for the prevention of stroke and systemic embolism. Today's clinician is faced with the difficult task of selecting a suitable OAC for a patient with a particular clinical profile or a particular pattern of risk factors and concomitant diseases. We reviewed analyses of subgroups of patients from trials of vitamin K antagonists vs. NOACs for stroke prevention in AF with the aim to identify patient groups who might benefit from a particular OAC more than from another. In the first of a two-part review, we discuss the choice of NOAC for stroke prevention in the following subgroups of patients with AF: (i) stable coronary artery disease or peripheral artery disease, including percutaneous coronary intervention with stenting and triple therapy; (ii) cardioversion, ablation and anti-arrhythmic drug therapy; (iii) mechanical valves and rheumatic valve disease, (iv) patients with time in therapeutic range of >70% on warfarin; (v) patients with a single stroke risk factor (CHA2DS2VASc score of 1 in males, 2 in females); and (vi) patients with a single first episode of paroxysmal AF. Although there are no major differences in terms of efficacy and safety between the NOACs for some clinical scenarios, in others we are able to suggest that particular drugs and/or doses be prioritized for anticoagulation.
Date Issued
2015-11-09
Date Acceptance
2015-11-01
Citation
EUROPEAN HEART JOURNAL, 2015, 38 (12), pp.852-859
ISSN
0195-668X
Publisher
Oxford University Press
Start Page
852
End Page
859
Journal / Book Title
EUROPEAN HEART JOURNAL
Volume
38
Issue
12
Copyright Statement
© 2016 The Author(s). Published on behalf of the European Society of Cardiology. All rights reserved. For permissions please email: journals.permissions@oup.com. This is a pre-copy-editing, author-produced version of an article accepted for publication in European Heart Journal following peer review. The definitive publisher-authenticated version Hans-Christoph Diener, James Aisenberg, Jack Ansell, Dan Atar, Günter Breithardt, John Eikelboom, Michael D. Ezekowitz, Christopher B. Granger, Jonathan L. Halperin, Stefan H. Hohnloser, Elaine M. Hylek, Paulus Kirchhof, Deirdre A. Lane, Freek W.A. Verheugt, Roland Veltkamp, Gregory Y.H. Lip; Choosing a particular oral anticoagulant and dose for stroke prevention in individual patients with non-valvular atrial fibrillation: part 1. Eur Heart J 2017; 38 (12): 852-859. doi: 10.1093/eurheartj/ehv643 is available online at: https://dx.doi.org/10.1093/eurheartj/ehv643
Identifier
http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000397146200007&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=1ba7043ffcc86c417c072aa74d649202
Subjects
Science & Technology
Life Sciences & Biomedicine
Cardiac & Cardiovascular Systems
Cardiovascular System & Cardiology
Non-valvular atrial fibrillation
Anticoagulation
Stroke prevention
Non-vitamin-K oral antagonist
HEART RHYTHM ASSOCIATION
ROCKET-AF TRIAL
PERIPHERAL ARTERY-DISEASE
ADDITIONAL RISK-FACTOR
VITAMIN-K ANTAGONISTS
RE-LY TRIAL
CATHETER ABLATION
CHA(2)DS(2)-VASC SCORE
ISCHEMIC-STROKE
UNINTERRUPTED RIVAROXABAN
Cardiovascular System & Hematology
1102 Cardiovascular Medicine And Haematology
Publication Status
Published