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Editorial
The real prize of direct oral anticoagulant blockbuster
  1. David J Seiffge,
  2. Thomas Raphael Meinel
  1. Neurology and Stroke Center, Inselspital Universitatsspital, Bern, Switzerland
  1. Correspondence to Dr David J Seiffge, Neurology and Stroke Center, Inselspital Universitatsspital, Bern 3010, Switzerland; david.seiffge{at}insel.ch

https://doi.org/10.1136/heartjnl-2020-318092

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    In our daily practice as stroke neurologists, we see many patients with atrial fibrillation. Most often, these patients suffered a feared complication of atrial fibrillation—ischaemic stroke. Every third of these patients had atrial fibrillation known before the stroke but did not take anticoagulants—this always feels like a sadly missed opportunity.1 On the other hand, we see patients suffering the most devastating complication of anticoagulation therapy—intracerebral haemorrhage. The high mortality and morbidity associated with intracerebral haemorrhage in patients taking anticoagulants is a real threat.2 For a long time, vitamin K antagonists were the only option for long-term anticoagulant therapy. However, many patients did not receive anticoagulant therapy despite a clear-cut indication due to a highly inconvenient treatment (repeated International Normalized Ratio measurements, many food and drug-interactions, frequent dose adjustments) and a significant risk of intracerebral (and other major) bleeding.

    We all follow the Hippocratic Oath ‘primum non nocere’, but having seen individual devastating cases of haemorrhage in patients taking anticoagulants leaves you with serious concerns about this treatment. However, not treating a patient with anticoagulants who has a clear indication exposes him/her to a much …

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    Footnotes

    • Contributors DJS wrote the first draft and TRM revised the draft for important intellectual content.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests DJS reports other (Advisory board fees used for research funding) from Bayer AG Switzerland, grants (Thrombosis Research Award 2017 used for research funding) from Bayer Foundation, outside the submitted work.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

    • Patient consent for publication Not required.

    • Provenance and peer review Commissioned; internally peer reviewed.

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