Which of the following is an anti-coagulant for atrial fibrillation in a patient with prior history of stroke, with reduced risk of haemorrhage?
Anticoagulants are the treatment of choice in patients with atrial fibrillation and prior stroke or transient ischemic attack (TIA). Vitamin K antagonists such as warfarin have long been the mainstay of therapy, but a new set of anticoagulants has emerged as a reasonable alternative that may indeed prove to have better efficacy and a reduced risk of hemorrhage. Apixaban is one such oral direct factor Xa inhibitor; it was recently shown to be likely more effective compared with warfarin in the Apixaban for the Prevention of Stroke in Subjects With Atrial Fibrillation (ARISTOTLE) trial. Clopidogrel combined with aspirin was more effective than aspirin alone in preventing vascular events, principally stroke, but increases the risk of major bleeding. Ref: 1. Easton JD et al. Apixaban compared with warfarin in patients with atrial fibrillation and previous stroke or transient ischaemic attack: A subgroup analysis of the ARISTOTLE trial. Lancet Neurol 2012;11:503. 2. Smith W.S., English J.D., Johnston S.C. (2012). Chapter 370. Cerebrovascular Diseases. In D.L. Longo, A.S. Fauci, D.L. Kasper, S.L. Hauser, J.L. Jameson, J. Loscalzo (Eds), Harrison's Principles of Internal Medicine, 18e.
Vitamin K antagonists
Apixaban
Clopidogrel
Ticlopidine