Why the study?
Clinicians encounter ongoing challenges when treating patients with AF and ischemic stroke with DOACs, including timing of initiation, dosing, comparative evidence, and management in patients without AF.
What is the optimal use, timing, and dosing of DOACs compared to VKAs in patients with ischemic stroke with or without atrial fibrillation?
What is the optimal use, timing, and dosing of DOACs compared to VKAs in patients with ischemic stroke with or without atrial fibrillation?
This review summarizes the evidence and clinical challenges regarding the use, timing, and dosing of DOACs in patients following an ischemic stroke.
Answers are grounded in this paper and cite their sources.
Supports DOAC preference in AF-related stroke; leaves optimal timing, dosing, and non-AF use open.
Direct oral anticoagulants (DOACs) are recommended over vitamin K antagonists (VKAs) in patients with atrial fibrillation (AF) and ischemic stroke. The main advantage of DOAC over VKA is the lower rate of bleeding and mortality. This review covers challenges clinicians can encounter when treating patients with AF and ischemic stroke, including timing of DOAC start and ongoing randomized clinical trials, appropriate dosing, and available comparative evidence across DOACs. For patients without AF but with an ischemic stroke, the review outlines the role of DOACs. Finally, the risk of thrombotic events associated with specific DOAC reversal agents and DOAC pausing is reviewed.
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Gian Marco De Marchis (2021) studied this question.
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