European Journal of Biomedical and Pharmaceutical Sciences

NOACS FOR STROKE PREVENTION IN PATIENTS WITH AF AND VTE: A SYSTEMATIC REVIEW AND META ANALYSIS

Nabila Unnisa Begum and Sathish Kumar Mittapalli*

ABSTRACT

The long term anticoagulation with warfarin has black box warning from Food and Drug Administration (FDA) bleeding problems warning, pregnancy warning, calciphylaxis warnings associated with various bleeding risks and drug-drug interactions and act by blocking vitamin K epoxide reductase (VKORC1) enzyme complex which led to development of novel drugs. The non-vitamin K antagonist oral anticoagulants (NOACs) are replacing warfarin for many indications. These agents include dabigatran, which inhibits thrombin, and rivaroxaban, apixaban, and edoxaban, which inhibit factor Xa for treatment of venous thromboembolism and rivaroxaban and apixaban are approved for thromboprophylaxis after elective hip or knee arthroplasty. The NOACs are effective as warfarin in reducing stroke and systemic embolism through anticoagulation with in fixed doses without routine coagulation monitoring but also are safer because they are associated with less intracranial bleeding, notably have prophylaxis for VTE after an orthopediac surgery and to prevent stroke in AF patient,a decreased risk of significant bleeding and other secondary adverse events. This review aims that beneficial effects of NOACs, pharmacokinetic and pharmacodynamic properties, mode of activities, common drug-drug interactions, pharmacological and identifies the doses of each approved indication, provides an overview on ongoing studies, the emerging real-world data and highlights the potential opportunities to identifies the remaining challenges.

Keywords: warfarin, AF, novel oral anticoagulant, stroke, VTE, vitamin k antagonist, rivaroxaban, apixaban, edoxaban, dabigatran.