Novel oral anticoagulants: A focused review for stroke physicians


  • Conflict of interest: MJOD is a member of the ACCP Antithrombotic Guidelines (Stroke Chapter). ERM is the recipient of Boehringer-Ingelheim Research Fellowship. J.W.E. has received honoraria and research support from Bayer Pharmaceuticals, Boehringer Ingelheim, Bristol-Myers Squibb, Daiichi Sankyo, Janssen, and Pfizer.
  • Funding: Health Research Board of Ireland Research Fellowship.


Novel oral anticoagulants provide an effective and convenient alternative to warfarin for stroke prevention in patients with atrial fibrillation. However, novel anticoagulants also present new challenges for stroke physicians, such as measurement of anticoagulant effect in emergency situations, use of thrombolysis in acute ischemic stroke, optimal timing of introduction of novel anticoagulants following acute ischemic stroke, and management of intracerebral hemorrhage. In this review, we propose pragmatic approaches to dealing with challenging management issues that will face stroke physicians who care for patients with acute stroke in the novel oral anticoagulant era.