Non vitamin K oral anticoagulants versus antiplatelets in embolic stroke of undetermined source: most updated evidence.

Non vitamin K oral anticoagulants versus antiplatelets in embolic stroke of undetermined source: most updated evidence. Minerva Cardioangiol. 2019 Jun 20;: Authors: Chatterjee S, Dubey S, Lahiri D, Ray BK Abstract Recent trial data have expanded the horizons of newer indications of non vitamin K oral anticoagulants (NOAC). Most recently they are being evaluated for use in embolic stroke of undetermined source (ESUS). ESUS are particularly known for their recurrences. So, identifying the causes and treating those etiological factors are the keys to secondary prevention of ESUS. Although traditional experts still opine for the use of antiplatelets for secondary prevention of ESUS as for other causes of embolic stroke, there are still room for improvement in delivery of optimal treatment strategy. So, NOAC is being tried as an alternative to traditional atiplatelet therapy in headtohead trials. Unfortunately, recent trial data (from NAVIGATEESUS and RESPECTESUS) have not shown any added benefits (with comparable bleeding risk) of NOAC compared to aspirin in prevention of ESUS. This review intends to highlight the concept of ESUS, its varied etiologies, discuss the published and ongoing trials and tries to dig the reasons why the overall trial data have been disappointing. It also discusses the arenas where NOAC may be proved to be better than antiplatelets. Overall, we have stressed on the personalized case-to-case basis decision making...
Source: Minerva Cardioangiologica - Category: Cardiology Tags: Minerva Cardioangiol Source Type: research