Non-Vitamin K Antagonist Oral Anticoagulant Use in Patients With Atrial Fibrillation and Associated Intracranial Hemorrhage: A Focused Review

Clin Cardiol. 2015 Nov;38(11):684-91. doi: 10.1002/clc.22434. Epub 2015 Jul 14.

Abstract

Atrial fibrillation (AF) is the most common cardiac arrhythmia and predisposes patients to an increased risk of embolic stroke. After nearly 60 years, warfarin is no longer the only effective therapeutic option for patients with AF. Large randomized trials have consistently shown that non-vitamin K oral anticoagulants (NOACs) including dabigatran, rivaroxaban, apixaban, and edoxaban significantly reduce from the risk of intracranial hemorrhage (ICH) compared with warfarin. We provide a focused review regarding the NOACs and ICH in AF patients by summarizing findings of these large clinical trials, mechanisms of lower ICH, reversal strategies with specific agents, and monitoring strategies.

Publication types

  • Review

MeSH terms

  • Administration, Oral
  • Anticoagulants / administration & dosage*
  • Anticoagulants / adverse effects*
  • Atrial Fibrillation / complications
  • Atrial Fibrillation / diagnosis
  • Atrial Fibrillation / drug therapy*
  • Blood Coagulation / drug effects*
  • Blood Coagulation Tests
  • Coagulants / therapeutic use
  • Drug Monitoring / methods
  • Humans
  • Intracranial Hemorrhages / chemically induced*
  • Intracranial Hemorrhages / diagnosis
  • Intracranial Hemorrhages / drug therapy
  • Predictive Value of Tests
  • Risk Assessment
  • Risk Factors
  • Stroke / diagnosis
  • Stroke / etiology
  • Stroke / prevention & control*
  • Treatment Outcome
  • Warfarin / administration & dosage
  • Warfarin / adverse effects

Substances

  • Anticoagulants
  • Coagulants
  • Warfarin