title: [The new anticoagulants - their role in secondary prevention of thromboembolism after stroke].
abstract: For many decades Vitamin K antagonists were the standard orally given medication for primary and secondary prevention of thromboembolism in patients with atrial fibrillation and stroke. Three compounds, dabigatran, rivaroxaban, and apixaban, are now challenging this well established prescription, as they showed similar effect in preventing thromboembolism with a lower bleeding rate in recently published well designed, controlled randomised, non-inferiority trials. Their advantages of each are to have a fixed dosage, no need to monitor coagulation factors, and fewer interactions with food and other drug intake. The therapeutic effect is estimated overall similar between the three compounds. Who is a candidate for one of the new drugs: Patients with atrial fibrillation and the clear indication to get a future oral anticoagulation are potential candidates to receive one of the new drugs. Further this may be patients where the treatment with Vit K antagonists was difficult to optimise, patients who are not willing to have blood controls done regularly or where blood controls are difficult to obtain. This will also be an option in patients who had a stroke due to atrial fibrillation and had no history of cerebral bleeding. Who should not receive the new anticoagulants: patients who present stable blood coagulation values in the treatment range and no complications should not be merged to the new drugs. Patients with severe renal insufficiency or receiving a medication that interacts with the new drugs (e. g. ketoconazole) or with synthetic heart valves will not be candidates to receive the new drugs.
authors.affiliation: Neurologie, Stroke Unit, Universitätsspital Basel.
authors.forename: D
authors.initials: D
authors.lastname: Seiffge
authors.forename: K
authors.initials: K
authors.lastname: Nedeltchev
authors.forename: P
authors.initials: P
authors.lastname: Lyrer
mesh_terms: D000284:Administration, Oral; D000925:Anticoagulants / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000097:blood / Q000150:complications; D001562:Benzimidazoles / Q000009:adverse effects / Q000627:therapeutic use; D000069604:Dabigatran; D006801:Humans; D019934:International Normalized Ratio; D009025:Morpholines / Q000009:adverse effects / Q000627:therapeutic use; D011720:Pyrazoles / Q000009:adverse effects / Q000627:therapeutic use; D011728:Pyridones / Q000009:adverse effects / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D000069552:Rivaroxaban; D055502:Secondary Prevention; D020521:Stroke / Q000097:blood / Q000188:drug therapy*; D013876:Thiophenes / Q000009:adverse effects / Q000627:therapeutic use; D013923:Thromboembolism / Q000097:blood / Q000517:prevention & control*; D014812:Vitamin K / Q000037:antagonists & inhibitors; D015091:beta-Alanine / Q000009:adverse effects / Q000031:analogs & derivatives / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D001562:Benzimidazoles; D009025:Morpholines; D011720:Pyrazoles; D011728:Pyridones; D013876:Thiophenes; D015091:beta-Alanine; D014812:Vitamin K; C522181:apixaban; D000069552:Rivaroxaban; D000069604:Dabigatran