New Anticoagulants as an Alternative to Aspirin in Atrial Fibrillation – Implications of the Apixaban versus Acetylsalicylic Acid to Prevent Strokes (AVERROES) Trial

2011 ◽  
Vol 7 (3) ◽  
pp. 196
Author(s):  
Raffaele De Caterina ◽  
Keyword(s):  
Atrial Fibrillation ◽  
Acetylsalicylic Acid ◽  
Vitamin K ◽  
Vitamin K Antagonists ◽  
Coagulation Factor ◽  
Clinical Information ◽  
Short Review ◽  
Factor X ◽  
New Anticoagulants ◽  
New Oral Anticoagulant

Atrial fibrillation (AF) is an extremely common arrhythmia, substantially increasing the risk of stroke and thromboembolism. Prevention of stroke and thromboembolism is, therefore, an important part of AF management. Guidelines until now have recommended that patients with AF receive some form of antithrombotic therapy, either as a vitamin K antagonist or aspirin, with a preference for anticoagulants in most cases. However, such current treatments are suboptimal, and despite recommendations, many patients do not receive adequate thromboprophylaxis because they are considered, for various reasons, ‘unsuitable’ to receive a vitamin K antagonists. In this patient population, apixaban, a new oral anticoagulant inhibiting activated coagulation factor X (FXa), administered in fixed doses and without anticoagulation monitoring, has undergone testing against aspirin in the recently published Apixaban versus acetylsalicylic acid to prevent strokes (AVERROES) trial. This short review will briefly address the strengths and limitations of this trial and the practical relevance of this new clinical information.

New Drugs for Thromboembolic Prevention in Atrial Fibrillation

2010 ◽  
Vol 6 (4) ◽  
pp. 64
Author(s):  
Jose L Merino ◽  
Jose López-Sendón ◽  
◽  
Keyword(s):  
Atrial Fibrillation ◽  
Vitamin K ◽  
Negative Impact ◽  
Vitamin K Antagonists ◽  
Coagulation Factor ◽  
Developed Countries ◽  
New Drugs ◽  
Risk Scores ◽  
Bleeding Events ◽  
Risk Patients

Atrial fibrillation (AF) is the most frequent sustained arrhythmia and its prevalence is increasing in developed countries. This progressive increase and the negative impact of this arrhythmia on the patient’s prognosis make AF one of the main healthcare problems faced today. This has led to intense research into the main aspects of AF, one of them being thromboembolism prevention. AF patients have a four to five times higher risk of stroke than the general population. Several factors increase thromboembolic risk in patients with AF and the use of risk scores, such as the Congestive Heart Failure, Hypertension, Age Greater than 75, Diabetes, and Prior Stroke or Transient Ischemic Attack (CHADS2), have been used to identify the best candidates for anticoagulation. Antithrombotic drugs are the mainstay of therapy for embolic prevention. The clinical use of these drugs is based on the risk–benefit ratio, where benefit is the reduction of stroke and systemic embolic events and risk is mostly driven by the increase in bleeding events. Generally, antiplatelets are indicated for low-risk patients in light of the fact anticoagulants are the drug of choice for moderate- or high-risk patients. Vitamin K antagonists have been the only option for oral anticoagulation for the last 50 years. However, these drugs have many pharmacodynamic and pharmacokinetic problems. The problems of anticoagulation with vitamin K antagonists have led to the investigation of new drugs that can be administered orally and have a better dose–response relationship, a shorter half-life and, in particular, higher efficacy and safety without the need for frequent anticoagulation controls. The drugs that have been studied most thoroughly in patients with AF are inhibitors of the activated coagulation factor X and inhibitors of coagulation factor II (thrombin), including ximelagatran and dabigatran. In addition, non-pharmacological therapies have been developed to prevent recurrent embolism in certain patient populations.

Antikoagulation bei Vorhofflimmern

2012 ◽  
Vol 32 (01) ◽  
pp. 37-39 ◽  
Author(s):  
C. Bode ◽  
M. Moser
Keyword(s):  
Atrial Fibrillation ◽  
Vitamin K ◽  
Vitamin K Antagonists ◽  
Bleeding Risk ◽  
Coagulation Factors ◽  
Additional Risk ◽  
New Anticoagulants ◽  
Therapeutic Anticoagulation ◽  
Impaired Quality

SummaryAtrial fibrillation is one of the most frequent reasons for therapeutic anticoagulation in everyday practice. Oral vitamin K antagonists such as Marcumar have been state of the art anticoagulants to prevent thrombembolic events in patients with atrial fibrillation and additional risk factors. But these drugs are accompanied by disadvantages such as increased bleeding risk and impaired quality of life caused by interactions with food or other medications as well as frequent controls of INRs.The new anticoagulants apixaban, rivaroxaban and dabigatran are direct antagonists of coagulation factors (FXa or FIIa) and demonstrate a promising risk/benefit profile in large clinical trials compared with vitamin K antagonists.Their approval for clinical use will open up new therapeutic perspectives for patients with atrial fibrillation and indication for anticoagulation.

Which Patients Would Be Willing to Change Anticoagulation From Vitamin-K Antagonists to a New Oral Anticoagulant?

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 4318-4318
Author(s):  
Job Harenberg ◽  
Svetlana Marx ◽  
Nadja Abou-Ayash ◽  
Christophe Kremer ◽  
Vera Hoeing ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Vitamin K ◽  
Logistic Regression Analysis ◽  
Oral Anticoagulant ◽  
Vitamin K Antagonists ◽  
Oral Anticoagulants ◽  
New Oral Anticoagulant ◽  
Willingness To Change

Abstract Abstract 4318 New oral anticoagulants have generated promising data on the prophylaxis of systemic and non-systemic embolism in patients with atrial fibrillation and treatment of acute venous thromboembolism and prolonged prophylaxis of recurrent events. For patients on chronic treatment with vitamin-K antagonists (VKA) we analysed the motivation and willingness to change the anticoagulation from VKA to new oral anticoagulants. Patients (n=110) on stable treatment with VKA for at least 3 months (indication for anticoagulation: atrial fibrillation or VTE) completed a validated personality inventory (Freiburger Persönlichkeitsinventar FPI-R), and a self-developed questionnaire on general attitudes regarding anticoagulant therapy (Q1). Patients were divided in two groups according to the reply to the question weather they were willing to switch to a new oral anticoagulant. Out of these sets of questions 7 questions were identified by means of a logistic regression analysis for the willingness to change anticoagulation with VKA to a new oral anticoagulant. The same patients completed this shortened questionnaire (Q2) (n=85) thereafter. Logistic regression analysis defined the 7 items of the FPI and Q1 questionaires as relevant for willingness of patients to change the medication. The probability to change medication was 98% using the 7 questions (Q2) compared to the 2 comlete questionnaires. The items were: extraversion – introversion scale on the FPI-R consisting of 14 questions, and from Q1: hope for a better quality of life with a new anticoagulant, no scepticism for new drugs, wish of a lack of routine monitoring for dose adjustment, relevance of the practitioners opinion, thoughts in the past of alternatives for anticoagulation, and difficulty to adjust the prothrombin time. Using Q2 85% of patients confirmed to be willing to change the anticoagulant drug compared to Q1 (chi square test p<0.0001). Seven questions were identified and confirmed to identify patients for their willingness to change anticoagulation from VKA to a new oral anticoagulant. Disclosures: No relevant conflicts of interest to declare.

Established anticoagulants in secondary haemostasis

2009 ◽  
Vol 29 (03) ◽  
pp. 241-246
Author(s):  
S. Ziemer ◽  
E. Langer
Keyword(s):  
Vitamin K ◽  
Dose Response ◽  
Oral Anticoagulation ◽  
Vitamin K Antagonists ◽  
Short Review ◽  
Response Control ◽  
New Anticoagulants

SummaryIn respect to the actual discussion of new anticoagulants in secondary haemostasis, we will give a short review on established oral anti -coagulation with vitamin K antagonists and parenteral anticoagulation by use of heparin. The different cumarin derivatives phenprocoumon, warfarin, and acenocoumarol are compared concerning to the management and influence of pharmacogenetic and pharmacokinetic factors. Studies to improve the safety of oral anticoagulation by vitamin K supplementation will be briefly discussed. The therapy with heparins include until now some problems of dose-response control. It is necessary to pay attention to contra-indications even for well known anticoagulants. Examples for that will be given.

scholarly journals Choice of New Oral Anticoagulant Agents Versus Vitamin K Antagonists in Atrial Fibrillation

2015 ◽  
Vol 21 (2) ◽  
pp. 150-156 ◽  
Author(s):  
José Moreno-Arribas ◽  
Vicente Bertomeu-González ◽  
Manuel Anguita-Sanchez ◽  
Ángel Cequier ◽  
Javier Muñiz ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Vitamin K ◽  
Oral Anticoagulant ◽  
Vitamin K Antagonists ◽  
Anticoagulant Agents ◽  
New Oral Anticoagulant

Anticoagulant Therapy in Atrial Fibrillation – Time for a Change?

2009 ◽  
Vol 5 (2) ◽  
pp. 57
Author(s):  
Raffaele De Caterina ◽  
Giulia Renda ◽  
◽  
Keyword(s):  
Atrial Fibrillation ◽  
Vitamin K ◽  
Vitamin K Antagonists ◽  
Dabigatran Etexilate ◽  
Anticoagulation Therapy ◽  
New Drugs ◽  
Phase Iii ◽  
Therapeutic Window ◽  
Randomized Evaluation ◽  
New Anticoagulants

Although to date warfarin and other vitamin K antagonists have clearly had the greatest efficacy among commonly available treatments in preventing stroke in atrial fibrillation, their use is associated with a substantial risk of major bleeding and is impractical because of their narrow therapeutic window, their interaction with drugs and foods and the need for frequent coagulation monitoring. Several new anticoagulants are undergoing phase III clinical trials in atrial fibrillation with the aim of demonstrating non-inferiority compared with vitamin K antagonists or superiority compared with aspirin in patients in whom vitamin K antagonists are contraindicated or not tolerated. In the recently released Randomized Evaluation of Long-Term Anticoagulation Therapy (RE-LY) trial, the first such drug, dabigatran etexilate, was proved substantially equivalent to 2–3 international normalised ratio (INR)-adjusted warfarin at the dosage of 110mg twice a day (BID), with superior efficacy at a dosage of 150mg BID. With these new drugs, cardiologists and internists are witnessing a real revolution in the thromboprophylaxis in atrial fibrillation.

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