Chapter 9: Anticoagulant Therapy for Stroke Prevention

1999 ◽  
Vol 9 (Suppl. 4) ◽  
pp. 47-52 ◽  
Keyword(s):  
Anticoagulant Therapy ◽  
Stroke Prevention

Review of Economics and Cost-Effectiveness Analyses of Anticoagulant Therapy for Stroke Prevention in Atrial Fibrillation in the US

2013 ◽  
Vol 47 (5) ◽  
pp. 671-685 ◽  
Author(s):  
Birgitta von Schéele ◽  
Maria Fernandez ◽  
Susan Lynn Hogue ◽  
Winghan Jacqueline Kwong
Keyword(s):  
Atrial Fibrillation ◽  
Cost Effectiveness ◽  
Anticoagulant Therapy ◽  
Stroke Prevention ◽  
The Us

Advances in Atrial Fibrillation-related Stroke Prevention

2015 ◽  
Vol 9 (2) ◽  
pp. 122
Author(s):  
Pierre Amarenco ◽  
Werner Hacke ◽  
Bo Norrving ◽  
Natalia Rost ◽  
◽  
...  
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Anticoagulant Therapy ◽  
Stroke Prevention ◽  
Stroke Risk ◽  
Oral Anticoagulants ◽  
Factor Xa ◽  
Haemorrhagic Stroke ◽  
Bleeding Events ◽  
Patients At Risk

In patients with atrial fibrillation (AF) the risk of stroke is substantially increased, especially in those who are elderly (over 75 years) or have risk factors such as previous stroke, heart failure or hypertension. Stroke outcomes are also generally much worse in those with AF. Current guidelines indicate that any patient with AF and risk factors for stroke should receive anticoagulant therapy to limit their stroke risk. Despite these established recommendations, only 50 % of patients at risk receive anticoagulation with a vitamin K antagonist (VKA) and only 50 % of those are within the therapeutic range, indicating lack of adherence to the guidelines. Withholding anticoagulant therapy is mainly left to an individual physician’s choice, as shown in the ongoing GARFIELD registry of AF stroke prevention practice. Many physicians fear the risk of intracranial haemorrhage (ICH) for which outcomes remain poor. Recent clinical studies have shown that the non-VKA oral anticoagulants (NOACs) (apixaban, rivaroxaban, dabigatran and edoxaban) significantly reduce the risk of ICH and other bleeding events, while having non-inferior stroke prevention to warfarin. Use of these drugs, limiting exposure to aspirin and alcohol and controlling blood pressure have been shown to minimise ICH risk in large clinical trials and meta-analyses. Recent data from the Effective aNticoaGulation with factor xA next GEneration in Atrial Fibrillation (ENGAGE AF)-TIMI 48 study showed that the factor Xa inhibitor edoxaban was non-inferior to well-managed warfarin for reducing all stroke risk, and significantly reduced haemorrhagic stroke, major bleeding, ICH and death. These findings further support the case for using NOAC therapy for stroke prevention in patients with AF and risk factors for stroke.

scholarly journals Anticoagulant therapy for stroke prevention in CKD patients

Nosotchu ◽  
2016 ◽  
Vol 38 (6) ◽  
pp. 449-454
Author(s):  
Makoto Nakajima ◽  
Masaki Watanabe ◽  
Yukio Ando
Keyword(s):  
Anticoagulant Therapy ◽  
Stroke Prevention

Antiplatelet and Anticoagulant Therapy in Stroke Prevention in African-Americans

1998 ◽  
pp. 167-179
Author(s):  
M.J. Schneck ◽  
S. Chaturvedi ◽  
D. Thompson ◽  
P.B. Gorelick
Keyword(s):  
African Americans ◽  
Anticoagulant Therapy ◽  
Stroke Prevention

scholarly journals Antithrombotic Therapy in the Prevention of Stroke

Biomedicines ◽  
2021 ◽  
Vol 9 (12) ◽  
pp. 1906
Author(s):  
Shyamal Bir ◽  
Roger E. Kelley
Keyword(s):  
Secondary Prevention ◽  
Antiplatelet Therapy ◽  
Anticoagulant Therapy ◽  
Stroke Prevention ◽  
Antithrombotic Therapy ◽  
Dual Antiplatelet Therapy ◽  
Recurrent Stroke ◽  
Oral Anticoagulants ◽  
Minor Stroke ◽  
Potential Clinical Benefit

Overview: Ischemic stroke is a leading cause of death and disability throughout the world. Antithrombotic therapy, which includes both antiplatelet and anticoagulant agents, is a primary medication of choice for the secondary prevention of stroke. However, the choices vary with the need to incorporate evolving, newer information into the clinical scenario. There is also the need to factor in co-morbid medical conditions as well as the cost ramifications for a particular patient as well as compliance with the regimen. Pertinent Updates: In the acute setting, dual antiplatelet therapy from three weeks to up to three months has become recognized as a reasonable approach for patients with either minor stroke or transient ischemic attack or those with symptoms associated with higher-grade intracranial stenosis. This approach is favored for non-cardioembolic stroke as a cardiogenic mechanism tends to be best managed with attention to the cardiac condition as well as anticoagulant therapy. Risk stratification for recurrent stroke is important in weighing potential risk versus benefits. For example, prolonged dual antiplatelet therapy, with a combination such as aspirin and clopidogrel or aspirin and ticagrelor, tends to have negation of the potential clinical benefit of stroke prevention, over time, by the enhanced bleeding risk. Anticoagulant choices are now impacted by newer agents, initially identified as novel oral anticoagulants (NOACs), which also became associated with “non-vitamin K” agents as they are no longer considered novel. Alternatively, they are now often identified as direct oral anticoagulants (DOACs). They tend to be viewed as superior or non-inferior to warfarin with the caveat that warfarin is still viewed as the agent of choice for stroke prevention in patients with mechanical heart valves. Conclusion: Based upon cumulative information from multiple clinical trials of secondary prevention of stroke, there is an increasing array of approaches in an effort to provide optimal management. Antithrombotic therapy, including in combination with anticoagulant therapy, continues to evolve with the general caveat that “one size does not fit all”. In view of this, we desire to provide an evidence-based approach for the prevention of stroke with antithrombotic agents.

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