title: Protecting the brain and the heart: antithrombotic treatment in nonvalvular atrial fibrillation.
abstract: Novel anticoagulants (NOACs) are the recent therapeutic breakthrough in the prophylaxis of stroke in patients with nonvalvular atrial fibrillation (NVAF). Patients with NVAF seem to have a high atherosclerotic burden, but it has not yet been established whether these agents also protect against cardiovascular disease (CVD). Different NOACs could have cardioprotective properties of different importance, but data come only from indirect comparisons. Patients with NVAF are at risk of stroke when there is concomitant atherosclerosis that also necessitates optimal treatment to reduce CVD risk. Combining antiplatelets with anticoagulants is a common clinical scenario and not always justified by current data and guidelines, putting patients at unnecessary bleeding risk. This review provides current knowledge about the cardioprotective properties of NOACs, the clinical importance of the link between CVD and NVAF, and the pitfalls of combining antiplatelet therapy with warfarin or NOACs.
authors.affiliation: 1Stroke Unit, CHU Brugmann, Brussels, Belgium.
authors.forename: Apostolos
authors.initials: A
authors.lastname: Safouris
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Anagnostis
authors.forename: Anna
authors.initials: A
authors.lastname: Karlovasitou
authors.forename: Spyridon
authors.initials: S
authors.lastname: Karras
authors.forename: Asterios
authors.initials: A
authors.lastname: Karagiannis
mesh_terms: D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000150:complications / Q000188:drug therapy*; D004359:Drug Therapy, Combination; D005343:Fibrinolytic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D012307:Risk Factors; D020521:Stroke / Q000209:etiology / Q000517:prevention & control*; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants; D005343:Fibrinolytic Agents; D010975:Platelet Aggregation Inhibitors
keywords: antiplatelets; apixaban; atrial fibrillation; cardiovascular disease; dabigatran; novel anticoagulants; rivaroxaban; warfarin