Anticoagulant therapy in a patient with a history of cerebral hemorrhage
Terapia anticoagulante in paziente con pregressa emorragia cerebrale
Several guidelines recommend the preferential use of NOAC compared to warfarin in patients with atrial fibrillation, based on evidence to support a efficacy similar to warfarin, but with a lower incidence of intracranial hemorrhage. The case described is a typical example of non-optimal use of NOACs in clinical practice: although the final choice of dabigatran 110 mg bid is in line with the recommendations of the guidelines and with the literature, the previous choice of administering enoxaparin is inadequate due to the presence of atrial fibrillation which makes the use of the drug off-label due to the lack of clinical data in this type of patient. Nevertheless, use of enoxaparin waiting to optimize anticoagulant therapy is very common in clinical practice. Non-inferiority in reagards to thromboembolic events and a superior safety profile in comparison to warfarin in the RE-LY study, make dabigatran 110 mg bid a suitable choice in clinical practice for patients at high risk of both thrombotic and hemorrhagic stroke (Cardiology).
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