Advertisement

Secondary Prevention of Stroke with Atrial Fibrillation by New Oral Anticoagulants

  • K. KamiyamaEmail author
  • T. Osato
  • H. Nakamura
Chapter
  • 578 Downloads

Abstract

We used the results of secondary prevention analyses for patients with a history of stroke or TIA in the large-scale RE-LY, ROCKET-AF (J-ROCKET-AF), and ARISTOTLE clinical trials to investigate the choice of new oral anticoagulants (NOACs) to prevent recurrent stroke. In light of these results, we concluded that dabigatran 150 mg BID should be the first-choice treatment for comparatively young patients with no apparent renal dysfunction, and apixaban for other patients, and that their efficacy and safety can be broadly guaranteed.

Keywords

NVAF (non-valvular atrial fibrillation) Previous stroke/TIA Secondary prevention for stroke Age Creatinine clearance 

References

  1. 1.
    Connolly SJ, Ezekowitz MD, Yusuf S, RE-LY Steering Committee and Investigators, et al. Dabigatran versus warfarin in patients with atrial fibrillation. N Engl J Med. 2009;361:1139–51.CrossRefPubMedGoogle Scholar
  2. 2.
    Patel MR, Mahaffey KW, Garg J, The ROCKET AF Investigators, et al. Rivaroxaban versus warfarin in nonvalvular atrial fibrillation. N Engl J Med. 2011;365:883–91.CrossRefPubMedGoogle Scholar
  3. 3.
    Hori M, Matsumoto M, Tanahashi N, on behalf of the J-ROCKET AF Study Investigators, et al. Rivaroxaban vs. warfarin in Japanese patients with atrial fibrillation. Circ J. 2012;76:2104–11.CrossRefPubMedGoogle Scholar
  4. 4.
    Granger CB, Alexander JH, McMurray JJ, ARISTOTLE Committees and Investigators, et al. Apixaban versus warfarin in patients with atrial fibrillation. N Engl J Med. 2011;365:981–92.CrossRefPubMedGoogle Scholar
  5. 5.
    Joint JCS, Working Group. Guidelines for pharmacotherapy of atrial fibrillation (JCS 2013). Circ J. 2014;78:1997–2021.CrossRefGoogle Scholar
  6. 6.
    Diener HC, Connolly SJ, Ezekowitz MD, for the RE-LY study group, et al. Dabigatran compared with warfarin in patients with atrial fibrillation and previous transient ischaemic attack or stroke: a subgroup analysis of the RE-LY trial. Lancet Neurol. 2010;9:1157–63.CrossRefPubMedGoogle Scholar
  7. 7.
    Hankey GJ, Patel MR, Stevens SR, for the ROCKET AF Steering Committee Investigators, et al. Rivaroxaban compared with warfarin in patients with atrial fibrillation and previous stroke or transient ischaemic attack: a subgroup analysis of ROCKET AF. Lancet Neurol. 2012;11:315–22.CrossRefPubMedGoogle Scholar
  8. 8.
    Tanahashi N, Hori M, Matsumoto M, et al. Rivaroxaban versus warfarin in Japanese patients with nonvalvular atrial fibrillation for the secondary prevention of stroke. J Stroke Cerebrovasc Dis. 2013;22:1317–25.CrossRefPubMedGoogle Scholar
  9. 9.
    Easton JD, Lopes RD, Bahit MC, for the ARISTOTLE Committees Investigators, et al. Apixaban compared with warfarin in patients with atrial fibrillation and previous stroke or transient ischaemic attack: a subgroup analysis of the ARISTOTLE trial. Lancet Neurol. 2012;11:503–11.CrossRefPubMedGoogle Scholar
  10. 10.
    Giugliano RP, Ruff CT, Braunwald E, for ENGAGE AF-TIMI 48 Investigators, et al. Edoxaban versus warfarin in patients with atrial fibrillation. N Engl J Med. 2013;28:2093–104.CrossRefGoogle Scholar
  11. 11.
    Hori M, Matsumoto M, Tanahashi N, et al. Rivarixaban vs. Warfarin in Japanese patients with non-valvular atrial fibrillation in relation to age: insight from J-ROCKET AF-. Circ J. 2014;78:1349–56.CrossRefPubMedGoogle Scholar
  12. 12.
    GY L, TB L, Skjøth F, et al. Indirect comparisons of new oral anticoagulant drugs for efficacy and safety when used for stroke prevention in atrial fibrillation. J Am Coll Cardiol. 2012;60:738–46.CrossRefGoogle Scholar
  13. 13.
    LH R, TB L, Graungaard T, et al. Primary and secondary prevention with new oral anticoagulant drugs for stroke prevention in atrial fibrillation: indirect comparison analysis. BMJ. 2012;345:e7097.CrossRefGoogle Scholar
  14. 14.
    Cairns JA. Which oral anticoagulant for which atrial fibrillation patient: Recent clinical trials and evidence-based choices. Can J Cardiol. 2013;29:1165–72.CrossRefPubMedGoogle Scholar
  15. 15.
    JI W, J. E. Incorporating edoxaban into the choice of anticoagulants for atrial fibrillation. Thromb Haemost. 2016 Jan;115:257–70.Google Scholar
  16. 16.
    AM S, GY. L. Choosing the right drug to fit the patient when selecting oral anticoagulation for stroke prevention in atrial fibrillation. J Intern Med. 2015;278:1–18.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media Singapore 2017

Authors and Affiliations

  1. 1.Stroke Center, Department of NeurosurgeryNakamura Memorial HospitalChuo-kuJapan

Personalised recommendations