title: 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 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.
authors.affiliation: Department of Neurological Surgery, Northwestern University Feinberg School of Medicine and McGaw Medical Center, 676 North St. Clair Street, Suite 2210, Chicago, IL 60611, USA.
authors.forename: Tarek Y
authors.initials: TY
authors.lastname: El Ahmadieh
authors.forename: Salah G
authors.initials: SG
authors.lastname: Aoun
authors.forename: Marc R
authors.initials: MR
authors.lastname: Daou
authors.forename: Najib E
authors.initials: NE
authors.lastname: El Tecle
authors.forename: Rudy J
authors.initials: RJ
authors.lastname: Rahme
authors.forename: Randall B
authors.initials: RB
authors.lastname: Graham
authors.forename: Joseph G
authors.initials: JG
authors.lastname: Adel
authors.forename: H
authors.initials: H
authors.lastname: Hunt Batjer
authors.forename: Bernard R
authors.initials: BR
authors.lastname: Bendok
mesh_terms: D000284:Administration, Oral; D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects; D001281:Atrial Fibrillation / Q000188:drug therapy; D002986:Clinical Trials as Topic; D006470:Hemorrhage / Q000188:drug therapy; D006801:Humans; D009493:Neurosurgery; D020521:Stroke / Q000517:prevention & control*
chemical_list: D000925:Anticoagulants
keywords: Atrial fibrillation; Dabigatran; Intracranial hemorrhage; Neurosurgery; Oral anticoagulant; Reversal