New frontiers in anticoagulation: non vitamin-K oral anticoagulants in stroke prevention

ABSTRACT

Introduction: Non vitamin-K oral anticoagulants (NOACs) are direct and specific inhibitors of the coagulation factors IIa (dabigatran) and Xa (apixaban, rivaroxaban, edoxaban) which share many pharmacokinetic properties. However, indications are lacking regarding the use of NOACs during thrombolysis, surgery and bleeding events.

Areas covered: In this paper, the authors retrospectively analyzed the relevant literature on the NOACs using the PubMed and Google Scholar databases.

Expert commentary: Although warfarin is effective in cardioembolic stroke prevention, easier handling and more favorable risk-benefit profile often render NOACs a more preferable therapy choice for neurologists. New evidences have suggested their use in treatment of elderly people, in patients with renal insufficiency or with antiphospholipid antibody syndrome. In addition, the use of antidotes, which rapidly reverse the anticoagulant effect of the NOACs, could be useful in bleeding, during emergency procedures, or in case of overdose.

KEYWORDS:

• Anticoagulation
• atrial fibrillation
• measure of monitoring
• stroke prevention
• reverse therapy
• non vitamin-K oral anticoagulants
• warfarin
• aspirin

Declaration of interest

Valentina Arnao, Marianna Riolo, Brigida Fierro and Paolo Aridon have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript (including employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending and royalties). Antonino Tuttolomondo and Antonio Pinto have received Speaker fees from Pfizer.

Additional information

Funding

This paper was not funded.