Non-vitamin K antagonist oral anticoagulants have proven efficacy for VTE prophylaxis, acute VTE, and concomitant ACS and AF, but failed to show benefit over aspirin in embolic stroke of undetermined source.
Do NOACs reduce thromboembolic events compared to standard therapy in patients with medical conditions at high risk of thromboembolism beyond atrial fibrillation?
This review highlights that while NOACs are highly effective for VTE and certain ACS/stable cardiovascular disease scenarios, they do not currently show superiority over aspirin for preventing recurrent stroke in unselected ESUS patients.
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.
Keun‐Sik Hong (Mon,) conducted a review in Cardiovascular diseases beyond atrial fibrillation (ESUS, ACS, stable atherosclerotic vascular disease, CHF, VTE). Non-Vitamin K antagonist oral anticoagulants (NOACs) vs. Standard of care (aspirin, warfarin, enoxaparin, placebo) was evaluated. Non-vitamin K antagonist oral anticoagulants have proven efficacy for VTE prophylaxis, acute VTE, and concomitant ACS and AF, but failed to show benefit over aspirin in embolic stroke of undetermined source.