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New Oral Anticoagulants for Stroke prevention

Rivaroxaban prevents stroke incidents to a large extent and its bleeding risk is also very low.

Dr. Shivrajan

Senior Cardiologist

Apollo Hospital, Chennai


Atrial fibrillation, the main cause of stroke, is unfortunately not diagnosed in many cases. Even when picked up, the treatment given is not always upto the mark,” says Dr. Shivaranjan. “Warfarin has been the mainstay of treatment but the arrival of newer anticoagulants, especially rivaroxaban, is going to change the whole scenario of anticoagulation” “Trials have confirmed the use of rivaroxaban to prevent pericardioversion and stroke incidence to a great extent. It is safer than warfarin due to a comparatively low bleeding risk. ‘One dose a day’ makes it effective in terms of compliance as well.” “Using anticoagulation for secondary prevention of stroke requires consideration of many parameters like the size of the stroke. In case of a big stroke, we wait until 12-14 days to revaluate and decide when to begin but for a mild stroke, we may start within a day or two.” “Renal function, liver function, age and drug interactions are other factors to be considered in secondary prevention of stroke. So far, there has not been any negative impact of the newer anticoagulants. Choosing patients carefully and monitoring coagulation profiles should do the trick

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Dr.Kunal Jhaveri

</b>Today we have the stroke neurovascular consultant Dr. Shivrajan from Oxford University and currently he is associated with Apollo Hospital, Chennai. Sir it is a warm welcome for this particular our show and revolutionary talk. So sir we have lot discussed regarding the atrial fibrillation from the cardiovascular point of view. Now neurological point of view also we want that the stroke is definitely one of the major concern. As a neurologist you have found in your patients but always we are talking about prevention, prevention, and prevention of a stroke in AF patients, so according to your point of view what is the importance of a primary prevention and if it is not happening then what is the need of a secondary prevention of stroke in AF patients.


Dr. Shivrajan

</b>From stroke point of view, TIA mini strokes or ischemic strokes, atrial fibrillation is one of the main causes which cause a stroke and unfortunately it is not picked up well enough <1


Dr.Kunal Jhaveri

</b>Okay, definitely, so it is a very strong point put on rivaroxaban, that it is one of the good molecule for the secondary prevention of stroke as well and as well as the primary prevention and DVT treatment and prophylaxis part also as well.


Dr. Shivrajan

</b>So in terms of secondary prevention, obviously it depends on the size of the stroke, if somebody has a big stroke I would wait for up to 12 to 14 days and then reevaluate to see when it can restart. If it is a mild stroke like TIA or mini stroke, I would even start within 24 to 48 hours or up to seven days after and as you know there are patients who may have <3


Dr.Kunal Jhaveri

</b>Definitely it is very well said. The second concern regarding that when the active ischemic stroke is developed in AF patients then there is definitely two kind of managements, one is medical conventional part and also surgical part also as well. So, according to your point of view, how you will stand both kind of treatment for the treatment of stroke in AF patient.


Dr. Shivrajan

</b>When you say medical versus surgical, surgical part is very little, the strokes that need surgical intervention are like hemorrhagic stroke or patient who have subarachnoid hemorrhage and so on. In minority of ischemic stroke patients who will develop malignant MCA syndrome where the whole brain swells up, they may need a hemicraniectomy. In those patients obviously, it is not advisable to start anticoagulants <4


Dr.Kunal Jhaveri

</b>Okay, so I think it is very well crisp but in detail discussion regarding the secondary prevention of stroke in AF patients. So the NOACs has a very good scope in this particular segment also, though already patients when neurologist part is also there, the patient is coming with a stroke and you have <5



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