New-generation oral anticoagulants for the prevention of stroke: Implications for neurosurgery

Abstract A new generation of oral anticoagulants, namely direct thrombin inhibitors and factor Xa inhibitors, have recently been approved for clinical use in patients with atrial fibrillation. These novel families of drugs have been shown to have favorable efficacy and safety profiles in multiple cl...

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Bibliographic Details
Published in:Journal of clinical neuroscience 2013-10, Vol.20 (10), p.1350-1356
Main Authors: El Ahmadieh, Tarek Y, Aoun, Salah G, Daou, Marc R, El Tecle, Najib E, Rahme, Rudy J, Graham, Randall B, Adel, Joseph G, Hunt Batjer, H, Bendok, Bernard R
Format: Article
Language:English
Subjects:
Administration, Oral
Anticoagulants - administration & dosage
Anticoagulants - adverse effects
Atrial fibrillation
Atrial Fibrillation - drug therapy
Clinical Trials as Topic
Dabigatran
Hemorrhage - drug therapy
Humans
Intracranial hemorrhage
Neurology
Neurosurgery
Oral anticoagulant
Reversal
Stroke - prevention & control
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Summary:Abstract A new generation of oral anticoagulants, namely direct thrombin inhibitors and factor Xa inhibitors, have recently been approved for clinical use in patients with atrial fibrillation. These novel families of drugs have been shown to have favorable efficacy and safety profiles in multiple clinical settings, particularly in the prevention of atrial fibrillation-related stroke, and are likely to become part of everyday practice, making a crossover to neurosurgical patients inevitable. Concern has risen regarding the complexity of managing intracranial and intraspinal hemorrhages related to these drugs. This review aims to provide an update on the most recent advances in oral anticoagulant drug therapy from a neurosurgeon’s perspective. We discuss current evidence for the use of these novel agents, their limitations, existing methods of drug-level monitoring, and controversies related to anticoagulation reversal. We also discuss specific topics such as anticoagulation resumption after intracranial or intraspinal bleeding, perioperative anticoagulant administration, and the possibility of combination with tissue plasminogen activator in the setting of acute ischemic stroke. A special focus is given to the incidence of intracranial and intraspinal hemorrhage associated with each drug.
ISSN:0967-5868
1532-2653
DOI:10.1016/j.jocn.2013.05.009