Dabigatran in Secondary Stroke Prevention: Clinical Experience with 106 Patients

DeFelipe-Mimbrera, Alicia; Cánovas, Araceli; Guillán, M.; Matute, Consuelo; Cantero, Susana; Cruz, Antônio Augusto Velasco e; Vera, Rocío; Masjuán, Jaime

doi:10.1155/2014/567026

Cited by 5 publications

(2 citation statements)

References 30 publications

(41 reference statements)

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“…In patients starting NOAC therapy, AIE were reported to occur more frequently during the first three months of treatment [12,13] with a declining AIE rate thereafter. Established risk factors such as previous AIE or an elevated CHA2DS2-VASc score were reported to predict AIE while using a NOAC [14–16].…”

Section: Resultsmentioning

confidence: 99%

Clinical presentation, diagnostic findings and management of cerebral ischemic events in patients on treatment with non-vitamin K antagonist oral anticoagulants – A systematic review

et al. 2019

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Background Non-vitamin K antagonist oral anticoagulants (NOAC) are equally or potentially superior in terms of effectiveness in the prevention of ischemic stroke and carry a lower associated risk of intracranial hemorrhage compared to Vitamin K antagonists. Nevertheless, ischemic strokes also occur in patients who are being treated with NOAC. In those particular patients, knowledge about the underlying stroke etiology, clinical presentation, acute management, and complication rates is scarce. Objective Systematic literature review to provide a comprehensive clinical overview in terms of presentation, laboratory, imaging parameters and outcomes of patients suffering from acute cerebral ischemic events (i.e. TIA and acute ischemic stroke) while on treatment with a NOAC. Only if available, comparison to VKA is presented which was not the primary focus of this analysis. Data sources PubMed/MEDLINE, Scopus and EMBASE from January 1, 2006, to November 20, 2018. Study eligibility criteria 52 studies providing detailed information on a total of 12247 patients were included. We excluded case reports and case series with less than five patients. Study appraisal and synthesis method We systematically assessed study quality using a bias tool and pooled consistent data. Results Existing data indicates milder stroke severity and smaller infarct size of acute ischemic stroke on treatment with NOAC compared to stroke occurrence on Vitamin K antagonists (VKA). Established risk factors for ischemic events also play a role in stroke while on NOACs, albeit the underlying etiology remains poorly understood. Intravenous thrombolysis and endovascular therapy seem to be safe and effective, but patient selection for recanalization therapies is challenging. Limitations Limited quality of published data, duplicate cases, statistical issues of data pooling, possible incomplete retrieval of identified research and reporting bias might have limited our findings. Conclusions Acute ischemic events despite treatment with NOAC therapy are insufficiently investigated. Systematic review registration number PROSPERO: CRD42018074853.

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Section: Resultsmentioning

confidence: 99%

Clinical presentation, diagnostic findings and management of cerebral ischemic events in patients on treatment with non-vitamin K antagonist oral anticoagulants – A systematic review

et al. 2019

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“…The ESC guidelines for non-valvular AF treatment recommend NOACs as the first line drugs [1], especially for patients on VKAs with unsatisfactory individual time in therapeutic range (TTR). Data from smaller studies showed that NOACs are safe and effective in real-world non-valvular AF patients also in secondary stroke prevention [13][14][15].…”

Section: Discussionmentioning

confidence: 99%

Randomized controlled clinical trials versus real-life atrial fibrillation patients treated with oral anticoagulants. Do we treat the same patients?

et al. 2013

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Background: The aim of the study was to compare clinical characteristics of real-life AF patients with populations included in randomized clinical trials (ROCKET AF and RELY). Methods: The analysis included 3528 patients who are participants of the ongoing, multicentre, retrospective CRAFT study. The study is registered in ClinicalTrials.gov: NCT02987062. The study is based on a retrospective analysis of hospital records of AF patients treated with vitamin K antagonists (VKAs) (acenocoumarol, warfarin) and nonvitamin K oral anticoagulants (NOACs) (dabigatran, rivaroxaban). CHADS2 score was used for risk of stroke stratification. Results: VKA was prescribed in 1973 (56.0%), while NOAC in 1549 (44.0%), including dabigatran-504 (14.3%) and rivaroxaban-1051 (29.8%), of the 3528 patients. VKA patients in the CRAFT study were at significantly lower risk of stroke (CHADS2 1.9 ± 1.3), compared with the VKA population from the RELY (2.1 ± 1.1) and the ROCKET-AF (3.5 ± 1.0). Patients in the CRAFT study treated with NOAC (CHADS2 for patients on dabigatran 150 mg-1.3 ± 1.2 and on rivaroxaban-2.2 ± 1.4) had lower risk than pts from the RELY (2.2 ± 1.2) and the ROCKET AF (3.5 ± 0.9). Conclusions: Real-world patients had a lower risk of stroke than patients included in the RELY and ROCKET AF trials.

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The Role of Nonvitamin K Antagonist Oral Anticoagulants (NOACs) in Stroke Prevention in Patients with Atrial Fibrillation

Кузнецов

Barcelona

Mohan

2016

Curr Neurol Neurosci Rep

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Anticoagulation is important in stroke prevention in patients with atrial fibrillation. Until recently, heparins and vitamin K antagonists were the only available therapy for stroke reduction in atrial fibrillation (AF) patients. Non-vitamin K antagonist oral anticoagulants (NOACs) including direct thrombin inhibitor (dabigatran) and direct factor Xa inhibitors (rivaroxaban, apixaban and edoxaban) are now available and offer new options for stroke prevention. This article reviews the available data on the use of NOACs for primary and secondary stroke prevention in AF patients and describes specific patient populations to guide clinician in making the informed decision regarding appropriate use of those agents. It also addresses the use of NOACs early after acute stroke and use of thrombolysis while on NOAC.

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Dabigatran in Secondary Stroke Prevention: Clinical Experience with 106 Patients

Cited by 5 publications

References 30 publications

Clinical presentation, diagnostic findings and management of cerebral ischemic events in patients on treatment with non-vitamin K antagonist oral anticoagulants – A systematic review

Clinical presentation, diagnostic findings and management of cerebral ischemic events in patients on treatment with non-vitamin K antagonist oral anticoagulants – A systematic review

Randomized controlled clinical trials versus real-life atrial fibrillation patients treated with oral anticoagulants. Do we treat the same patients?

The Role of Nonvitamin K Antagonist Oral Anticoagulants (NOACs) in Stroke Prevention in Patients with Atrial Fibrillation

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