Choosing a particular oral anticoagulant and dose for stroke prevention in individual patients with non-valvular atrial fibrillation: part 2.


Journal Article (Review)

The choice of oral anticoagulant (OAC) for patients with atrial fibrillation (AF) may be influenced by individual clinical features or by patterns of risk factors and comorbidities. We reviewed analyses of subgroups of patients from trials of vitamin K antagonists vs. non-vitamin K oral anticoagulants (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 addition, we discuss the timing of initiation of anticoagulation. In the second of a two-part review, we discuss the use of NOAC for stroke prevention in the following subgroups of patients with AF: (vii) secondary stroke prevention in patients after stroke or transient ischaemic attack (TIA), (viii) patients with acute stroke requiring thrombolysis or thrombectomy, (ix) those initiating or restarting OAC treatment after stroke or TIA, (x) those with renal impairment on dialysis, (xi) the elderly, (xii) those at high risk of gastrointestinal bleeding, and (xiii) those with hypertension. In addition, we discuss adherence and compliance. Finally, we present a summary of treatment suggestions. In specific subgroups of patients with AF, evidence supports the use of particular NOACs and/or particular doses of anticoagulant. The appropriate choice of treatment for these subgroups will help to promote optimal clinical outcomes.

Full Text

Duke Authors

Cited Authors

  • Diener, H-C; Aisenberg, J; Ansell, J; Atar, D; Breithardt, G; Eikelboom, J; Ezekowitz, MD; Granger, CB; Halperin, JL; Hohnloser, SH; Hylek, EM; Kirchhof, P; Lane, DA; Verheugt, FWA; Veltkamp, R; Lip, GYH

Published Date

  • March 21, 2017

Published In

Volume / Issue

  • 38 / 12

Start / End Page

  • 860 - 868

PubMed ID

  • 28158531

Pubmed Central ID

  • 28158531

Electronic International Standard Serial Number (EISSN)

  • 1522-9645

Digital Object Identifier (DOI)

  • 10.1093/eurheartj/ehw069


  • eng

Conference Location

  • England