With improvements in overall life expectancy, more patients are being treated with anticoagulation for chronic conditions and receive chemoprophylaxis after surgical procedures. A number of new medications have been approved to prevent stroke caused by nonvalvular atrial fibrillation and to treat and decrease the incidence of venous thromboembolism. Novel agents include dabigatran, which inhibits thrombin. Newer agents have a number of advantages over warfarin, including rapid onset with shorter half-lives and fixed doses that do not require monitoring. A number of trials have demonstrated therapeutic noninferiority of newer agents over warfarin, including a reduction in major bleeding and up to 50% reduction in cerebral and fatal hemorrhage.
Starke RM, Komotar RJ, Connolly ES. Neurosurgery 2015;77:N11–3.