Old and new oral anticoagulants for secondary stroke prevention in atrial fibrillation

Tommaso Sacquegna, Anna Zaniboni, Andrea Rubboli, Gaetano Procaccianti, Michela Crisci, Fabiola Maioli, Giorgia Arnone, Giuseppe Di Pasquale

Research output: Contribution to journalArticle

Abstract

Vitamin K antagonists, such as warfarin, used in oral anticoagulation therapy currently represent the standard drugs for the primary and secondary prevention of stroke in non-valvular atrial fibrillation (AF), with a relative risk reduction close to 70%. Newer oral anticoagulants, such as direct thrombin inhibitors (i.e., dabigatran) and direct factor Xa inhibitors (i.e., apixaban and rivaroxaban) have been recently compared with warfarin in large randomized trials for stroke prevention in AF. The new oral anticoagulants showed, compared with warfarin, no statistically significant difference in the rate of stroke or systemic embolism in secondary prevention (patients with previous transient ischemic attack or stroke) subgroups. With regard to safety, the risk of intracranial bleeding was reduced with new anticoagulants compared with warfarin. Indirect treatment comparisons of clinical trials on secondary prevention cohorts showed no significant difference in efficacy among apixaban, rivaroxaban, and dabigatran; but dabigatran 110 mg was associated with less intracranial bleedings than rivaroxaban.

Original languageEnglish
Pages (from-to)314-322
Number of pages9
JournalItalian Journal of Medicine
Volume9
Issue number4
DOIs
Publication statusPublished - 2015

Keywords

  • Apixaban
  • Atrial fibrillation
  • Dabigatran
  • Rivaroxaban
  • Secondary prevention of stroke
  • Warfarin

ASJC Scopus subject areas

  • Medicine(all)

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