TY - JOUR
T1 - Old and new oral anticoagulants for secondary stroke prevention in atrial fibrillation
AU - Sacquegna, Tommaso
AU - Zaniboni, Anna
AU - Rubboli, Andrea
AU - Procaccianti, Gaetano
AU - Crisci, Michela
AU - Maioli, Fabiola
AU - Arnone, Giorgia
AU - Di Pasquale, Giuseppe
PY - 2015
Y1 - 2015
N2 - 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.
AB - 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.
KW - Apixaban
KW - Atrial fibrillation
KW - Dabigatran
KW - Rivaroxaban
KW - Secondary prevention of stroke
KW - Warfarin
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U2 - 10.4081/itjm.2015.468
DO - 10.4081/itjm.2015.468
M3 - Article
AN - SCOPUS:84956669535
VL - 9
SP - 314
EP - 322
JO - Italian Journal of Medicine
JF - Italian Journal of Medicine
SN - 1877-9344
IS - 4
ER -