Pharmacodynamics of oral anticoagulants in patients with atrial fibrillation in the acute period of ischemic stroke

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Abstract

Background. Every fifth ischemic stroke is caused by a patient’s history of atrial fibrillation. Nowadays, direct and indirect oral anticoagulants are widely used to prevent thromboembolic complications in patients with atrial fibrillation. However, despite the prescription of this group of drugs, every year 1–2% of patients with atrial fibrillation have an ischemic stroke. In this situation, a number of questions take rise: if it is possible to carry out thrombolytic therapy in the patients who have been taking anticoagulants; if it is worth resuming anticoagulant therapy after a stroke; when exactly this should be done; and what drugs should be used to prevent another stroke.

The aim of this review was to summarize the available clinical guidelines and research results on the study of the anticoagulant therapy characteristics in patients with atrial fibrillation after an ischemic stroke.

Materials and methods. For this review, the information presented in the scientific literature from open and available sources, has been used. The information had been placed in the following electronic databases: PubMed, Scopus, Web of Science Core Collection, Cochrane Library, ClinicalTrials.gov; Elibrary, Cyberleninka, Google Academy. The covering period was 1997–2020.

The search queries were: “ischemic stroke + atrial fibrillation + anticoagulants”; “ischemic stroke + atrial fibrillation + direct oral coagulants” and “atrial fibrillation + ischemic stroke + warfarin” in both Russian and English equivalents.

Results and conclusion. Currently, the problem of the use of anticoagulants for the prevention of recurrent thromboembolic complications in patients with AF in the acute period of a stroke, is studied insufficiently. The difficulties are caused by the delivery of TLT in the patients who have been taking DOACs, first of all, due to the impossibility of an accurate assessment of the hemostasis state because of the unavailability of routine specific tests; and second, as a result of the lack of registered antidotes for most drugs, and their high costs. Besides, there are no RCTs dedicated to the study of the optimal time for the resumption or initiation of anticoagulant therapy in the acute period of an IS, and the optimal drugs for this group of patients. Most of the existing recommendations on these aspects, are based on the consensus of experts, and this fact indicates the need for further research in the area under review.

About the authors

Vladimir I. Petrov

Volgograd State Medical University

Author for correspondence.
Email: brain@sprintnet.ru
ORCID iD: 0000-0002-0258-4092

Doctor of Sciences (Medicine), Professor, Academician of Russian Academy of Sciences, the Head of the Department of Clinical Pharmacology and Intensive Care, Chief Freelance Specialist – Clinical Pharmacologist of the Ministry of Health of the Russian Federation, Honored Scientist of the Russian Federation, Honored Physician of the Russian Federation

Russian Federation, 1, Pavshikh Bortsov Sq., Volgograd, 400131

Anastasia S. Gerasimenko

Volgograd State Medical University

Email: 16any_61@mail.ru
ORCID iD: 0000-0002-7957-3770

Assistant, Department of Clinical Pharmacology and Intensive Care

Russian Federation, 1, Pavshikh Bortsov Sq., Volgograd, 400131

Vladislav S. Gorbatenko

Volgograd State Medical University

Email: vsgorbatenko@volgmed.ru
ORCID iD: 0000-0002-6565-2566

Candidate of Sciences (Medicine), Associate Professor of the Department of Clinical Pharmacology and Intensive Care

Russian Federation, 1, Pavshikh Bortsov Sq., Volgograd, 400131

Olga V. Shatalova

Volgograd State Medical University

Email: ovshatalova@volgmed.ru
ORCID iD: 0000-0002-7311-4549

Doctor of Sciences (Medicine), Professor of the Department of Clinical Pharmacology and Intensive Care

Russian Federation, 1, Pavshikh Bortsov Sq., Volgograd, 400131

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Supplementary files

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2. Figure 1 – Treatment tactics of a patient taking DOACs in the acute period of ischemic stroke(adapted by J. Steffeletal, 2018 [12])

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3. Figure 2 – Initiation/resumption of anticoagulant therapy after transient ischemic attack/ischemic stroke(adapted from J. Steffeletal, 2018 [12])

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Copyright (c) 2020 Petrov V.I., Gerasimenko A.S., Gorbatenko V.S., Shatalova O.V.

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