ARAMIS: Addressing Real-world Anticoagulant Management Issues in Stroke


Addressing real-world anticoagulant management issues in stroke (ARAMIS) registry: management of acute stroke patients on treatment with non-vitamin K antagonist oral anticoagulants...the better our stroke treatment data, the better your stroke patient outcomes


Management of Acute Stroke Patients on Treatment with New Oral Anticoagulants: Addressing Real-world Anticoagulant Management Issues in Stroke (ARAMIS) Registry
 
Clinical practice for the management of non-valvular atrial fibrillation (AF) is rapidly changing. While vitamin K antagonist (warfarin) has been the most widely used anticoagulant for decades, long-term warfarin therapy involves multiple food and drug interactions, frequent blood testing and dose adjustment, requirements that make it cumbersome to use for many patients. This has led to the quest of new oral anticoagulants that are effective, safe and convenient to use in clinical practice.
 
Between 2010 and 2012, three new oral anticoagulants (dabigatran, rivaroxaban, and apixaban) were approved by US Food and Drug Administration (FDA) for stroke prophylaxis in AF patients. Despite their efficacy showed in randomized clinical trials, patients on these novel agents still are at risk for a stroke. Results from RE-LY, ARISTOTLE, and ROCKET-AF trials found between 1-2% of treated patients in the trials have an ischemic stroke. While less common than on warfarin therapy, up to 0.5% of patients on a novel anticoagulant will have a hemorrhagic stroke per year. Yet the optimal management of patients who experienced either an acute ischemic stroke (AIS) or intracerebral hemorrhage (ICH) while on novel anticoagulants remains unclear. With the rapid adoption of new oral anticoagulants in the United States, clinicians will inevitably face this therapeutic dilemma.


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