From novel to routine: new oral anticoagulants for stroke prevention in primary care in Ireland

2020 ◽  
Vol 26 (12) ◽  
pp. 1-4
Author(s):  
Ann Kirby ◽  
Aileen Murphy ◽  
Colin Bradley
Keyword(s):  
Atrial Fibrillation ◽  
Primary Care ◽  
Patient Group ◽  
Patient Experience ◽  
Stroke Prevention ◽  
Oral Anticoagulants ◽  
Healthcare Services ◽  
New Oral Anticoagulants ◽  
Prescribing Practice ◽  
New Treatments

New treatments for atrial fibrillation provide promising opportunities to increase the efficiency of healthcare services while optimising the patient experience. However, research shows that current prescribing practice for this patient group is inconsistent and at odds with international guidelines.

New oral anticoagulants for stroke prevention in atrial fibrillation: impact of study design, double counting and unexpected findings on interpretation of study results and conclusions

2014 ◽  
Vol 111 (05) ◽  
pp. 798-807 ◽  
Author(s):  
Jeremy S. Paikin ◽  
Jack Hirsh ◽  
Mandy N. Lauw ◽  
John W. Eikelboom ◽  
Jeffrey S. Ginsberg ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Study Design ◽  
Stroke Prevention ◽  
Oral Anticoagulants ◽  
New Oral Anticoagulants ◽  
Double Counting ◽  
Unexpected Events ◽  
Study Results ◽  
Unexpected Findings ◽  
Routine Coagulation

SummaryFour recently introduced new oral anticoagulants (dabigatran, rivaroxaban, apixaban and edoxaban) have been shown to be at least as efficacious and safe as warfarin for stroke prevention in patients with atrial fibrillation in their respective trials. The first three have been approved, while edoxaban is awaiting regulatory approval. Several guidelines have endorsed the approved new oral anticoagulants over warfarin because of their favourable risk-benefit ratio, low propensity for food and drug interactions, and lack of requirement for routine coagulation monitoring. In this invited review, we summarise the results of the four studies and discuss widely held conclusions. We take a step further and discuss how differences in study design, analysis plan, and unexpected events affect the interpretation of the study results. Finally, we take our re-interpretation of study results and discuss how they might impact clinical practice and anticoagulant choice for patients.

scholarly journals Stroke Prevention in Atrial Fibrillation: Understanding the New Oral Anticoagulants Dabigatran, Rivaroxaban, and Apixaban

Thrombosis ◽  
2012 ◽  
Vol 2012 ◽  
pp. 1-10 ◽  
Author(s):  
Tan Ru San ◽  
Mark Yan Yee Chan ◽  
Teo Wee Siong ◽  
Tang Kok Foo ◽  
Ng Kheng Siang ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Stroke Prevention ◽  
Primary Care Physicians ◽  
Vitamin K Antagonists ◽  
Oral Anticoagulants ◽  
New Oral Anticoagulants ◽  
Phase Iii ◽  
Fixed Dose ◽  
Thrombin Inhibitor ◽  
Factor X

Unlike vitamin K antagonists (VKAs), the new oral anticoagulants (NOACs)—direct thrombin inhibitor, dabigatran, and direct activated factor X inhibitors, rivaroxaban, and apixaban—do not require routine INR monitoring. Compared to VKAs, they possess relatively rapid onset of action and short halflives, but vary in relative degrees of renal excretion as well as interaction with p-glycoprotein membrane transporters and liver cytochrome P450 metabolic enzymes. Recent completed phase III trials comparing NOACs with VKAs for stroke prevention in atrial fibrillation (AF)—the RE-LY, ROCKET AF, and ARISTOTLE trials—demonstrated at least noninferior efficacy, largely driven by significant reductions in haemorrhagic stroke. Major and nonmajor clinically relevant bleeding rates were acceptable compared to VKAs. Of note, the NOACs caused significantly less intracranial haemorrhagic events compared to VKAs, the mechanisms of which are not completely clear. With convenient fixed-dose administration, the NOACs facilitate anticoagulant management in AF in the community, which has hitherto been grossly underutilised. Guidelines should evolve towards simplicity in anticipation of greater use of NOACs among primary care physicians. At the same time, the need for caution with their use in patients with severely impaired renal function should be emphasised.

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