Oral Anticoagulation and the Novel Oral Anticoagulants (NOACs):Where Are We at Midterm?

Academic Content

Program Overview

Faculty Presentations

Introduction Deepak L. Bhatt Elaine Hylek

Video Roundtable

Current Activity

Elaine Hylek, MD, MPH, Boston University School of Medicine, Boston, Massachusetts

NOACs in Clinical Care NOACS Prevention Data NOACS: Major Bleeding Meta-Analysis ESC 2012 Guidelines Update Garfield Registry Prophylaxis vs Anticoagulation Clinical Trial: Major Bleeding Benefit and Risk Bleeding Risk Score Consensus Statements CHA2DS2-VASc Bleeding Risk Score Circulation Article Patient Age vs TTR NOACs vs Warfarin NOACS & Renal Dysfunction EHRA NOACs Practical Guide Procedural Management NOACs Bleeding Management Life-threatening Hemorrhage CAT Scans of Cerebral Hemorrhage Intracerebral Hemorrhage: Limited Data Kcentra: FDA approval Safety: Meta-analysis Anticoagulation Antidotes Dose Differences: AFib vs VTE NOACS in Clinical Practice Continuing role for warfarin?

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Antiplatelet Prophylaxis vs Anticoagulation

Figure 7 is from a meta-analysis that compared the effect of warfarin versus aspirin.[5] From the results of this nicely done study it can be seen that basically all of the trials found a clear benefit for warfarin compared to antiplatelet (or aspirin) therapy for reduction of risk of stroke.

In aggregate, analysis of all 11 trials of this meta-analysis shows, with a very tight confidence intervals, that the results overwhelmingly favor anticoagulation over antiplatelet therapy for reduction of stroke risk in patients with AFib.

Hylek EM. Am J Med 2014; 00.

References

[5]

Aguilar MI, Hart R, Pearce LA. Oral anticoagulants versus antiplatelet therapy for preventing stroke in patients with non-valvular atrial fibrillation and no history of stroke or transient ischemic attack. Cochrane Database Syst Rev. 2007;(3):CD006186.