J Stroke.  2019 Sep;21(3):259-275. 10.5853/jos.2019.01970.

Non-Vitamin K Antagonist Oral Anticoagulants in Medical Conditions at High Risk of Thromboembolism beyond Atrial Fibrillation

Affiliations
  • 1Department of Neurology, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea. nrhks@paik.ac.kr

Abstract

Non-Vitamin K antagonist oral anticoagulants (NOACs) have been extensively investigated in medical conditions at high risk of venous or arterial thrombosis other than atrial fibrillation (AF), including hip or knee arthroplasty, acute venous thromboembolism (VTE), cancer-associated VTE, acute coronary syndrome (ACS), stable atherosclerotic vascular disease, chronic heart failure, and embolic stroke of undetermined source (ESUS). Two large ESUS trials failed to show the benefit of rivaroxaban or dabigatran, and large randomized controlled trial (RCT) data of NOACs are lacking for another potential candidates of patent foramen ovale-related stroke, acute ischemic stroke, and cerebral venous thrombosis. On the other hand, high quality evidences of NOACs have been compiled for VTE prophylaxis after hip or knee arthroplasty, acute VTE, cancer-associated VTE, and concomitant ACS and AF, which have been reflected in clinical practice guidelines. In addition, RCTs showed the benefit of very low dose rivaroxaban in combination with antiplatelet therapy in patients with ACS and in those with stable cardiovascular disease. This article summarizes the accumulated evidences of NOACs in cardiovascular diseases beyond AF, and aims to inform healthcare providers of optimal regimens tailored to individual medical conditions and help investigators design future clinical trials.

Keyword

Anticoagulants; Stroke; Atrial fibrillation; Acute coronary syndrome; Venous thromboembolism; Cardiovascular diseases

MeSH Terms

Acute Coronary Syndrome
Anticoagulants*
Arthroplasty, Replacement, Knee
Atrial Fibrillation*
Cardiovascular Diseases
Dabigatran
Hand
Health Personnel
Heart Failure
Hip
Humans
Research Personnel
Rivaroxaban
Stroke
Thromboembolism*
Thrombosis
Vascular Diseases
Venous Thromboembolism
Venous Thrombosis
Anticoagulants
Dabigatran
Rivaroxaban
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