What is the role of novel oral anticoagulants (NOACs) in stroke prevention in patients with atrial fibrillation (AF)?

Updated: Dec 18, 2018
  • Author: Salvador Cruz-Flores, MD, MPH, FAHA, FCCM, FAAN, FACP, FANA; Chief Editor: Helmi L Lutsep, MD  more...
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Answer

Novel oral anticoagulants (NOACs) include apixaban, dabigatran, rivaroxaban, and edoxaban. NOACs are alternatives to warfarin for high-risk patients (including those with a history of stroke) who have atrial fibrillation. [24, 25, 26, 27, 28, 29] Apixaban, edoxaban, and rivaroxaban inhibit Factor Xa, whereas dabigatran is a direct thrombin inhibitor. Apixaban and dabigatran were shown to be superior to warfarin for the prevention of stroke and systemic embolism, while rivaroxaban and edoxaban were shown to be equivalent. The rates of intracranial hemorrhage are lower for NOACs compared with warfarin. Dabigatran carries a higher risk of gastrointestinal bleeding compared with warfarin, and it appears to increase the risk of myocardial infarction. [24] These medications have not been compared against each other.


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