title: Choosing a particular oral anticoagulant and dose for stroke prevention in individual patients with non-valvular atrial fibrillation: part 2.
abstract: The choice of oral anticoagulant (OAC) for patients with atrial fibrillation (AF) may be influenced by individual clinical features or by patterns of risk factors and comorbidities. We reviewed analyses of subgroups of patients from trials of vitamin K antagonists vs. non-vitamin K oral anticoagulants (NOACs) for stroke prevention in AF with the aim to identify patient groups who might benefit from a particular OAC more than from another. In addition, we discuss the timing of initiation of anticoagulation. In the second of a two-part review, we discuss the use of NOAC for stroke prevention in the following subgroups of patients with AF: (vii) secondary stroke prevention in patients after stroke or transient ischaemic attack (TIA), (viii) patients with acute stroke requiring thrombolysis or thrombectomy, (ix) those initiating or restarting OAC treatment after stroke or TIA, (x) those with renal impairment on dialysis, (xi) the elderly, (xii) those at high risk of gastrointestinal bleeding, and (xiii) those with hypertension. In addition, we discuss adherence and compliance. Finally, we present a summary of treatment suggestions. In specific subgroups of patients with AF, evidence supports the use of particular NOACs and/or particular doses of anticoagulant. The appropriate choice of treatment for these subgroups will help to promote optimal clinical outcomes.
authors: Department of Neurology, University Hospital Essen, Essen, Germany.
authors: Hans-Christoph
authors: HC
authors: Diener
authors: Icahn School of Medicine at Mount Sinai, New York, USA.
authors: James
authors: J
authors: Aisenberg
authors: Hofstra North Shore/LIJ School of Medicine, Hempstead, USA.
authors: Jack
authors: J
authors: Ansell
authors: Division of Medicine, Oslo University Hospital, Ullevål and University of Oslo, Norway.
authors: Dan
authors: D
authors: Atar
authors: Division of Rhythmology, Department of Cardiovascular Medicine, Hospital of the University Münster, Münster, Germany.
authors: Günter
authors: G
authors: Breithardt
authors: Population Health Research Institute, McMaster University, Hamilton, ON, Canada.
authors: John
authors: J
authors: Eikelboom
authors: Cardiovascular Research Foundation, New York, NY, USA.|Thomas Jefferson University Sidney Kimmel Medical College, Philadelphia, PA, USA.|Lankenau Medical Center, Wynnewood, PA, USA.
authors: Michael D
authors: MD
authors: Ezekowitz
authors: Department of Medicine, Duke University, Durham, NC, USA.
authors: Christopher B
authors: CB
authors: Granger
authors: Icahn School of Medicine at Mount Sinai, Mount Sinai Medical Center, New York, NY, USA.
authors: Jonathan L
authors: JL
authors: Halperin
authors: Division of Clinical Electrophysiology, Department of Cardiology, J. W. Goethe University, Frankfurt, Germany.
authors: Stefan H
authors: SH
authors: Hohnloser
authors: Boston Medical Center, Boston University School of Medicine, Boston, MA, USA.
authors: Elaine M
authors: EM
authors: Hylek
authors: Institute of Cardiovascular Sciences, University of Birmingham, SWBH and UHB NHS Trusts, Birmingham, UK.|Department of Cardiovascular Medicine, Hospital of the University of Münster, Münster, Germany.
authors: Paulus
authors: P
authors: Kirchhof
authors: University of Birmingham, Institute of Cardiovascular Sciences, City Hospital, Birmingham, UK.
authors: Deirdre A
authors: DA
authors: Lane
authors: Afdeling Cardiologie, Hartcentrum OLVG, Amsterdam, The Netherlands.
authors: Freek W A
authors: FWA
authors: Verheugt
authors: Imperial College London, London, UK.
authors: Roland
authors: R
authors: Veltkamp
authors: University of Birmingham, Birmingham, UK.|Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
authors: Gregory Y H
authors: GYH
authors: Lip
mesh_terms: D000284:Administration, Oral; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects; D001281:Atrial Fibrillation / Q000150:complications*; D000066491:Clinical Decision-Making; D000075203:Contraindications, Drug; D004334:Drug Administration Schedule; D006471:Gastrointestinal Hemorrhage / Q000150:complications; D006801:Humans; D006973:Hypertension / Q000150:complications; D002546:Ischemic Attack, Transient / Q000150:complications; D055118:Medication Adherence; D006435:Renal Dialysis / Q000009:adverse effects; D051436:Renal Insufficiency, Chronic / Q000150:complications; D012307:Risk Factors; D055502:Secondary Prevention; D020521:Stroke / Q000517:prevention & control*; D015912:Thrombolytic Therapy / Q000009:adverse effects
chemical_list: D000925:Anticoagulants
keywords: Anticoagulation; Non-valvular atrial fibrillation; Non-vitamin K oral antagonist; Stroke prevention