J Korean Neurol Assoc.  2022 Feb;40(1):1-14. 10.17340/jkna.2022.1.1.

Use of Non-Vitamin K Dependent Oral Anticoagulant in Ischemic Stroke

• Park H
• Yoo J

• KMID: 2525346
• DOI: http://doi.org/10.17340/jkna.2022.1.1

Abstract

Atrial fibrillation (AF) is associated with an increased incidence of ischemic stroke and transient ischemic attack. A confluence of various factors such as blood stasis, endothelial dysfunction, and prothrombotic state could be contributing to the thrombogenesis in AF. Anticoagulation is the first-line therapy for the prevention of thromboembolism by AF. In current days, non-vitamin K dependent oral anticoagulants (NOAC) are considered as the preferred choice of anticoagulants to prevent ischemic stroke in patients with AF. NOACs have comparable good efficacy and better safety with a predictable anticoagulant effect without the routine coagulation monitoring compared to vitamin K dependent oral anticoagulant. However, the proper use of NOACs needs a careful approach to many practical aspects for balancing the preventing thromboembolic events and bleeding risk. Thus, understanding the drug metabolism and indication of NOAC for a specific situation is essential. In this article, we review major clinical trials, the mechanism, and the use of NOACs in the actual clinical setting of managing ischemic stroke patients.

Keyword

Ischemic stroke; Anticoagulants; Dabigatran; Rivaroxaban; Apixaban; Edoxaban