title: Novel oral anticoagulant management issues for the stroke clinician.
abstract: Four nonvitamin K antagonist oral anticoagulants (NOACs) are approved for stroke prevention in patients with nonvalvular atrial fibrillation (NVAF).
  
  
  
  In this review, we assemble available evidence for the best management of ischemic and hemorrhagic stroke patients in the context of NOAC use.
  
  
  
  NOACs provide predictable anticoagulation with fixed dosages. The direct thrombin inhibitor dabigatran and direct factor Xa inhibitors apixaban, edoxaban, and rivaroxaban are all noninferior to warfarin for the prevention of ischemic stroke and systemic embolism and are associated with reduced incidence of intracranial hemorrhage. While these agents offer treatment options for NVAF patients, they also present challenges specific to the clinician managing cerebrovascular disease patients.
  
  
  
  We summarize available evidence and current approaches to the initiation, dosing, monitoring and potential reversal of NOACs in stroke patients.
authors.affiliation: Division of Neurology, Department of Medicine, University of Alberta, Edmonton, Canada Division of General Internal Medicine, Department of Medicine, University of Alberta, Edmonton, Canada.
authors.forename: Andrew
authors.initials: A
authors.lastname: Wassef
authors.affiliation: Division of Neurology, Department of Medicine, University of Alberta, Edmonton, Canada ken.butcher@ualberta.ca.
authors.forename: Ken
authors.initials: K
authors.lastname: Butcher
mesh_terms: D000284:Administration, Oral; D000818:Animals; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use*; D002545:Brain Ischemia / Q000188:drug therapy; D002543:Cerebral Hemorrhage / Q000188:drug therapy; D006801:Humans; D055502:Secondary Prevention; D020521:Stroke / Q000188:drug therapy*
chemical_list: D000925:Anticoagulants
keywords: NOAC; Stroke; nonvitamin K antagonist oral anticoagulant; secondary prevention