Asian Patients with Stroke plus Atrial Fibrillation and the Dose of Non-Vitamin K Oral Anticoagulants
After recent randomized control trials (RCTs), non-vitamin K oral anticoagulants (NAOAs) are now widely being used in patients with atrial fibrillation (AF) worldwide. However, current guidelines for the use of NOACs in patients with AF are derived mostly using a Caucasian population and non-stroke...
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Korean Stroke Society
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doaj-ee9ba50f446542d5974587d0550d9fa42020-11-25T04:02:19ZengKorean Stroke SocietyJournal of Stroke2287-63912287-64052016-05-0118216917810.5853/jos.2016.00052128Asian Patients with Stroke plus Atrial Fibrillation and the Dose of Non-Vitamin K Oral AnticoagulantsOh Young Bang0Keun-Sik Hong1Ji Hoe Heo2 Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea Department of Neurology, Ilsan Paik Hospital, Inje University, Goyang, Korea Department of Neurology, Yonsei University College of Medicine, Seoul, KoreaAfter recent randomized control trials (RCTs), non-vitamin K oral anticoagulants (NAOAs) are now widely being used in patients with atrial fibrillation (AF) worldwide. However, current guidelines for the use of NOACs in patients with AF are derived mostly using a Caucasian population and non-stroke patients. Relatively few Asian patients with AF and stroke are included in the recent RCTs. As a result, the optimal use of NOACs in this particular group of patients is remains to be settled. The optimal dose of NOACs and response to current dose of NOACs of Asian patients with AF and stroke may differ from those of westerners and patients without stroke. We reviewed available research on NOACs by searching PubMed and ClinicalTrials.gov published in English up to December 2015. In this review, the characteristics of Asian AF patients with prior stroke/transient ischemic attack, which might influence the efficacy and safety profiles of NOACs, are discussed. In addition, we summarize the risk factors for bleeding complications on NOACs, which are related or unrelated with the blood level of NOACs. Lastly, we provide recent data of reduced dose of NOACs from RCTs or large cohorts. The results reviewed herein call for clinical trials to test whether a reduced dose of NOACs is beneficial in Asian patients with AF and stroke. In the meantime, further researches are needed to establish the safety and efficacy of dose-adjusted NOACs considering both blood levels of NOACs and fragility of patients in Asian patients with AF and stroke.http://www.j-stroke.org/upload/pdf/jos-2016-00052.pdfanticoagulationatrial fibrillationasiansstrokeischemic strokehemorrhage |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Oh Young Bang Keun-Sik Hong Ji Hoe Heo |
spellingShingle |
Oh Young Bang Keun-Sik Hong Ji Hoe Heo Asian Patients with Stroke plus Atrial Fibrillation and the Dose of Non-Vitamin K Oral Anticoagulants Journal of Stroke anticoagulation atrial fibrillation asians stroke ischemic stroke hemorrhage |
author_facet |
Oh Young Bang Keun-Sik Hong Ji Hoe Heo |
author_sort |
Oh Young Bang |
title |
Asian Patients with Stroke plus Atrial Fibrillation and the Dose of Non-Vitamin K Oral Anticoagulants |
title_short |
Asian Patients with Stroke plus Atrial Fibrillation and the Dose of Non-Vitamin K Oral Anticoagulants |
title_full |
Asian Patients with Stroke plus Atrial Fibrillation and the Dose of Non-Vitamin K Oral Anticoagulants |
title_fullStr |
Asian Patients with Stroke plus Atrial Fibrillation and the Dose of Non-Vitamin K Oral Anticoagulants |
title_full_unstemmed |
Asian Patients with Stroke plus Atrial Fibrillation and the Dose of Non-Vitamin K Oral Anticoagulants |
title_sort |
asian patients with stroke plus atrial fibrillation and the dose of non-vitamin k oral anticoagulants |
publisher |
Korean Stroke Society |
series |
Journal of Stroke |
issn |
2287-6391 2287-6405 |
publishDate |
2016-05-01 |
description |
After recent randomized control trials (RCTs), non-vitamin K oral anticoagulants (NAOAs) are now widely being used in patients with atrial fibrillation (AF) worldwide. However, current guidelines for the use of NOACs in patients with AF are derived mostly using a Caucasian population and non-stroke patients. Relatively few Asian patients with AF and stroke are included in the recent RCTs. As a result, the optimal use of NOACs in this particular group of patients is remains to be settled. The optimal dose of NOACs and response to current dose of NOACs of Asian patients with AF and stroke may differ from those of westerners and patients without stroke. We reviewed available research on NOACs by searching PubMed and ClinicalTrials.gov published in English up to December 2015. In this review, the characteristics of Asian AF patients with prior stroke/transient ischemic attack, which might influence the efficacy and safety profiles of NOACs, are discussed. In addition, we summarize the risk factors for bleeding complications on NOACs, which are related or unrelated with the blood level of NOACs. Lastly, we provide recent data of reduced dose of NOACs from RCTs or large cohorts. The results reviewed herein call for clinical trials to test whether a reduced dose of NOACs is beneficial in Asian patients with AF and stroke. In the meantime, further researches are needed to establish the safety and efficacy of dose-adjusted NOACs considering both blood levels of NOACs and fragility of patients in Asian patients with AF and stroke. |
topic |
anticoagulation atrial fibrillation asians stroke ischemic stroke hemorrhage |
url |
http://www.j-stroke.org/upload/pdf/jos-2016-00052.pdf |
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