Could the novel oral anticoagulants prevent stroke?

This study investigated the current antithrombotic therapy and the potential benefits of novel oral anticoagulants (apixaban, dabigatran) in patients with atrial fibrillation (AF).

One of the major causes of stroke is represented by atrial fibrillation (abnormal heart rhythm). To prevent thrombus (blood clot) formation, drugs like antiplatelets (aspirin, clopidogrel) and anticoagulants (warfarin) are being used. Regular monitoring, the difficulty to sustain target INR (International Normalized Ratio – a blood test that measures how quickly a patient’s blood clots) and the various food/drug interactions limit the usage of anticoagulants. Recent clinical trials demonstrate that novel oral anticoagulation (NOACs) can become an alternative therapy.

For this study, 1,034 Chinese patients with AF were followed up for a period of 1.9 years. Patients were treated with aspirin, clopidogrel, warfarin, or combinations of these agents. Stroke/thromboembolism (TE – blood clot formation and blocking of arteries) and major bleeding associated to antithrombotic treatment were investigated. Statistical analysis was used to compare the use of these drugs with NOACs such as apixaban and dabigatran in preventing stroke/TE and major bleeding.

Results showed that the risk for major bleeding was higher for the use of warfarin compared with aspirin and clopidogrel. Also, aspirin or clopidogrel were ineffective for stroke prevention in patients with AF. Statistical analysis showed that, in patients at high risk of stroke, NOACs such as apixaban and dabigatran could better prevent stroke/TE, with only minor bleeding adverse effects. 

In summary, this study showed that there was suboptimal stroke prevention with no difference between antiplatelet and anticoagulant-treated patients. The use of the NOACs (apixaban and dabigatran) could provide better stroke prevention compared to antiplatelet (or warfarin) use in this Chinese population with AF.

This study included only Chinese patients, so it is not certain whether these results could apply to other populations. Also, further clinical trials are needed to compare the actual effects of the NOACs with antiplatelet and warfarin use in stroke prevention in patients with AF.

Consult with your physician regarding treatment with anticoagulants.