Date of Award
Spring 2021
Degree Name
Master of Medical Science (Physician Assistant)
Department
Physician Assistant; College of Health Sciences
First Advisor
Zachary Weik
Abstract
Abstract
Introduction: For many years, warfarin was the drug of choice for ischemic stroke patients when atrial fibrillation was determined to be the most likely etiology. Given the significant risk of recurrent strokes in this patient population, it is paramount that these patients are treated with anticoagulation therapy for prevention of further cardioembolic strokes. In recent years, there has been a shift from the use of warfarin to the use of novel oral anticoagulants in this patient population. Although these novel oral anticoagulants seem to be the preferred choice of anticoagulation in recent years , the question still remains if they are superior at preventing recurrent strokes in patients with atrial fibrillation. This research hopes to determine which treatment option provides patients with the most effective option for recurrent stroke prevention, and which should be the drug of choice. In stroke patients diagnosed with atrial fibrillation (P), are novel oral anticoagulants (NOACs) (I) more effective at preventing recurrent strokes (O) when compared to warfarin(C)?
Methods: Multiple literature searches were performed in efforts to compile the most relevant and applicable research articles. Using PubMed, Google Scholar, and Academic Search Ultimate, a tailored search was performed using terms such as “recurrent stroke prevention AND atrial fibrillation OR anticoagulation OR warfarin OR NOAC” to yield relevant results. Inclusion and exclusion criteria were then applied to the search in order to compile the most appropriate articles in regards to the proposing question.
Results: Overall, the evidence provided by the results of these research articles indicated that novel oral anticoagulants were not significantly superior to warfarin in regards to recurrent stroke prevention in patients with atrial fibrillation. The data supported that the efficacy of NOACs were comparable to that of warfarin in this population.
Discussion: On the basis of these results, there is no significant data to support that NOACs are more effective at preventing ischemic strokes than warfarin. The results demonstrated that the two anticoagulation options are comparable in that regard. A limited sample population and lack of long-term data throughout the studies may have contributed to this lack of clinical significance. Therefore, the conclusion cannot be drawn as to which anticoagulant should be the drug of choice when treating stroke patients with atrial fibrillation.
Conclusion: For many years, warfarin has been the treatment of choice for stroke patients deemed appropriate for anticoagulation therapy. With newer drugs on the market, it remains unclear which treatment option should be the standard of care when treating patients with atrial fibrillation. Given the insufficient evidence found throughout the research, the conclusion cannot be made which should be the drug of choice. Based on efficacy, warfarin and NOACs are comparable and neither drug had the clinical significance to change the standard of care. Providers must look at various other factors when determining what is the drug of choice for individual patients and an anticoagulant option should be tailored to the patient's comorbidities, risk factors, and personal preference.
Recommended Citation
Evangelista, Gina, "Recurrent Stroke Prevention in Atrial Fibrillation Patients" (2021). Capstone Showcase. 74.
https://scholarworks.arcadia.edu/showcase/2021/pa/74
Recurrent Stroke Prevention in Atrial Fibrillation Patients
Abstract
Introduction: For many years, warfarin was the drug of choice for ischemic stroke patients when atrial fibrillation was determined to be the most likely etiology. Given the significant risk of recurrent strokes in this patient population, it is paramount that these patients are treated with anticoagulation therapy for prevention of further cardioembolic strokes. In recent years, there has been a shift from the use of warfarin to the use of novel oral anticoagulants in this patient population. Although these novel oral anticoagulants seem to be the preferred choice of anticoagulation in recent years , the question still remains if they are superior at preventing recurrent strokes in patients with atrial fibrillation. This research hopes to determine which treatment option provides patients with the most effective option for recurrent stroke prevention, and which should be the drug of choice. In stroke patients diagnosed with atrial fibrillation (P), are novel oral anticoagulants (NOACs) (I) more effective at preventing recurrent strokes (O) when compared to warfarin(C)?
Methods: Multiple literature searches were performed in efforts to compile the most relevant and applicable research articles. Using PubMed, Google Scholar, and Academic Search Ultimate, a tailored search was performed using terms such as “recurrent stroke prevention AND atrial fibrillation OR anticoagulation OR warfarin OR NOAC” to yield relevant results. Inclusion and exclusion criteria were then applied to the search in order to compile the most appropriate articles in regards to the proposing question.
Results: Overall, the evidence provided by the results of these research articles indicated that novel oral anticoagulants were not significantly superior to warfarin in regards to recurrent stroke prevention in patients with atrial fibrillation. The data supported that the efficacy of NOACs were comparable to that of warfarin in this population.
Discussion: On the basis of these results, there is no significant data to support that NOACs are more effective at preventing ischemic strokes than warfarin. The results demonstrated that the two anticoagulation options are comparable in that regard. A limited sample population and lack of long-term data throughout the studies may have contributed to this lack of clinical significance. Therefore, the conclusion cannot be drawn as to which anticoagulant should be the drug of choice when treating stroke patients with atrial fibrillation.
Conclusion: For many years, warfarin has been the treatment of choice for stroke patients deemed appropriate for anticoagulation therapy. With newer drugs on the market, it remains unclear which treatment option should be the standard of care when treating patients with atrial fibrillation. Given the insufficient evidence found throughout the research, the conclusion cannot be made which should be the drug of choice. Based on efficacy, warfarin and NOACs are comparable and neither drug had the clinical significance to change the standard of care. Providers must look at various other factors when determining what is the drug of choice for individual patients and an anticoagulant option should be tailored to the patient's comorbidities, risk factors, and personal preference.