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Use of rivaroxaban in patients with stroke

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Abstract

Rivaroxaban, an inhibitor of Factor Xa, is a direct oral anti-coagulant that has been found to be non-inferior to warfarin in preventing cerebral ischemia in patients with non-valvular atrial fibrillation and in the subgroup of patients with a history of the previous stroke or transient ischemic attack. Vascular neurologists in daily clinical practice may encounter patients taking rivaroxaban or patients who may benefit from its use. In this paper, we review the current clinical indications, contraindications, and clinical management guidelines for rivaroxaban while providing a special focus on neurological aspects and expert opinions on rivaroxaban therapy management in various situations that a neurologist may encounter when treating patients with an ischemic stroke (including those requiring intravenous or intra-arterial reperfusion therapy) and patients with an intracerebral hemorrhage. Since data from clinical trials and real-life data are missing in some clinical situations, strong recommendations are not always available. Nevertheless, practical guidelines should be adopted to maximize benefits from this oral anti-coagulant.

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Acknowledgements

We gratefully acknowledge Dr. Anna Poggesi for her help on the issue of concomitant anti-platelet therapy.

Author information

Authors and Affiliations

  1. Unità di Trattamento Neurovascolare, University La Sapienza Rome, Viale del Policlinico 155, 00161, Rome, Italy

    Danilo Toni

  2. Department of Applied Clinical Sciences and Biotechnology, University of L’Aquila, L’Aquila, Italy

    Antonio Carolei

  3. Stroke Unit, Perugia, Italy

    Valeria Caso

  4. U.O. Neurologia e Stroke Unit, PO “G. Jazzolino”, Vibo Valentia, VV, Italy

    Domenico Consoli

  5. S.C. Neurologia, Ente Ospedaliero Ospedali Galliera Genova, Genoa, Italy

    Massimo Del Sette

  6. Department of NEUROFARBA, Neuroscience SectionUniversity of Florence, Florence, Italy

    Domenico Inzitari

  7. Institute of Neuroscience, Italian National Research Council, Florence, Italy

    Domenico Inzitari

  8. SC Neurologia e Stroke UnitAzienda Ospedaliera G. Brotzu, Cagliari, Italy

    Maurizio Melis

  9. Dipartimento di Neurologia d’Urgenza, IRCCS Fondazione Istituto Neurologico Nazionale C. Mondino, Pavia, Italy

    Giuseppe Micieli

  10. Clinica Neurologica, Università Politecnica delle Marche, Ancona, Italy

    Leandro Provinciali

  11. UO Neurologia, USL Umbria 1, Sedi di Città di Castello e Branca, Trento, Italy

    Stefano Ricci

  12. Fondazione IRCCS Ospedale Maggiore Policlinico, Milan, Italy

    Paola Santalucia

  13. Italian Stroke Organisation, Florence, Italy

    Vito Toso

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  1. Danilo Toni
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  2. Antonio Carolei
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  3. Valeria Caso
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Correspondence to Danilo Toni.

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Conflict of interest

Danilo Toni has received honoraria for speakers’ bureau and is member of advisory boards of Boehringer Ingelheim, Bayer, Pfizer-BMS. Valeria Caso has received honoraria for speakers’ bureau from Boehringer Ingelheim, Daiichi Sankyo, Pfizer-BMS and Ever Pharma and is member of advisory boards of Boeringher Ingelheim. Domenico Inzitari has received fees for conferences and research grants from Bayer and Shire. Giuseppe Micieli has received honoraria for speakers’ bureau and consultant fees from Bayer, Lundbeck, Pfizer, and Boehringer Ingelheim. Stefano Ricci has received payments for attending meetings from Bayer, Boehringer Ingelheim, and Medtronics.

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Editorial assistance was provided by Ercules Comunicazioni with funding by Bayer Italy.

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Toni, D., Carolei, A., Caso, V. et al. Use of rivaroxaban in patients with stroke. Neurol Sci 38, 745–754 (2017). https://doi.org/10.1007/s10072-017-2855-3

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