Old and new oral anticoagulants for secondary stroke prevention in atrial fibrillation

  • Tommaso Sacquegna Neurology-Stroke Unit, Institute of Neurological Sciences, Bologna, Italy.
  • Anna Zaniboni | a.zaniboni@ausl.bo.it Neurology-Stroke Unit, Institute of Neurological Sciences, Bologna, Italy.
  • Andrea Rubboli Department of Cardiology, Maggiore Hospital, Bologna, Italy.
  • Gaetano Procaccianti Neurology-Stroke Unit, Institute of Neurological Sciences, Bologna, Italy.
  • Michela Crisci Neurology-Stroke Unit, Institute of Neurological Sciences, Bologna, Italy.
  • Fabiola Maioli Geriatric and Stroke Unit, Medical Department, Maggiore Hospital, Bologna, Italy.
  • Giorgia Arnone Geriatric and Stroke Unit, Medical Department, Maggiore Hospital, Bologna, Italy.
  • Giuseppe Di Pasquale Department of Cardiology, Maggiore Hospital, Bologna, Italy.

Abstract

Vitamin K antagonists, such as warfarin, used in oral anticoagulation therapy currently represent the standard drugs for the primary and secondary prevention of stroke in non-valvular atrial fibrillation (AF), with a relative risk reduction close to 70%. Newer oral anticoagulants, such as direct thrombin inhibitors (i.e., dabigatran) and direct factor Xa inhibitors (i.e., apixaban and rivaroxaban) have been recently compared with warfarin in large randomized trials for stroke prevention in AF. The new oral anticoagulants showed, compared with warfarin, no statistically significant difference in the rate of stroke or systemic embolism in secondary prevention (patients with previous transient ischemic attack or stroke) subgroups. With regard to safety, the risk of intracranial bleeding was reduced with new anticoagulants compared with warfarin. Indirect treatment comparisons of clinical trials on secondary prevention cohorts showed no significant difference in efficacy among apixaban, rivaroxaban, and dabigatran; but dabigatran 110 mg was associated with less intracranial bleedings than rivaroxaban.

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Published
2015-12-15
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Issue
Section
Reviews
Keywords:
Secondary prevention of stroke, warfarin, apixaban, rivaroxaban, dabigatran, atrial fibrillation.
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How to Cite
Sacquegna, T., Zaniboni, A., Rubboli, A., Procaccianti, G., Crisci, M., Maioli, F., Arnone, G., & Di Pasquale, G. (2015). Old and new oral anticoagulants for secondary stroke prevention in atrial fibrillation. Italian Journal of Medicine, 9(4), 314-322. https://doi.org/10.4081/itjm.2015.468

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