Antithrombotics in the prevention of cerebrovascular accidents: Part II - Significance of anticoagulant therapy
Abstract
Cerebrovascular accidents of ischemic etiology most frequently occur in the background of atherothrombosis, in which case antiplatelet treatment plays a crucial role in the prophylaxis, or they are of thromboembolic origin, usually related to cardioembolization, in which case prevention is based on anticoagulant treatment. The strategy of blockage of primary haemostasis was the subject of the first part of the overview while this part focuses on the inhibition of secondary haemostasis, i.e. on anticoagulants.
Currently, we have anti-vitamins K available in the indication of prophylaxis of thromboembolic incidents in patients with atrial fibrillation, specifically warfarin, which inhibits more coagulation factors, or direct inhibitors of thrombin (dabigatran) or factor Xa (rivaroxaban and, awaiting approval for clinical use, apixaban). Considering the great inter- and intra-individual variability of the effect of warfarin in the background of interactions with drugs and food as well as of pharmacogenetic influences, the slow onset of action and several other unfavourable pharmacological properties, the above-mentioned direct inhibitors of thrombin or factor Xa were introduced.
Direct comparison with warfarin has demonstrated the greater efficacy and safety of the newly introduced anticoagulants