Safety and Efficacy of Using NOAC as Prevention of Ischemic Stroke in the Geriatric Population with Atrial Fibrillation – Review Article

Trawka, Paulina; Kwietniewska, Milena; Falkowski, Marcin; Kędziora-Kornatowska, Kornelia

doi:10.36145/JHSM2022.04

Abstract

Introduction

Atrial fibrillation is a common arrhythmia in the elderly population, which may lead to thromboembolic events complicated by ischemic stroke. The frequency increases with age along with other chronic diseases such as diabetes or hypertension. Non-vitamin K antagonist oral anticoagulants (NOACs) are the main drugs used in the prevention of stroke, taking the place of vitamin K antagonists (VKAs).

Materials and Methods

The article reviews the literature using the Pubmed and Google Scholar databases. Articles were analyzed using keywords: atrial fibrillation, elderly, NOAC, VKA, ischemic stroke.

Results

Many studies have shown that NOACs are a groundbreaking achievement in treating thromboembolic events such as ischemic stroke, even in the elderly. Their efficiency and safety surpasses VKAs as they have better pharmacokinetics and pharmacodynamics along with a wider therapeutic index, no need for monitoring, less risk of interactions and fatal bleeding, but with higher risk of gastrointestinal bleeding.

Conclusion

NOACs are efficient and safe in the elderly with atrial fibrillation for ischemic stroke prevention. Caution should be kept in patients with renal failure or a prosthetic valve. Interactions are not serious but possible when taking NOACs with drugs such as carbamazepine. Investigation is still indicated for reviewing this issue further.

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