scholarly journals Cardiovascular Pharmacotherapies Focus: Are low doses of direct-acting oral anticoagulants justified and appropriate in patients with nonvalvular atrial fibrillation?

2016 ◽  
Vol 11 (2) ◽  
pp. 115-117 ◽  
Author(s):  
Antoni Martínez-Rubio ◽  
Gheorghe-Andrei Dan
Keyword(s):  
Atrial Fibrillation ◽  
Oral Anticoagulants ◽  
Low Doses ◽  
Nonvalvular Atrial Fibrillation ◽  
Direct Acting ◽  
Direct Acting Oral Anticoagulants

scholarly journals A systematic review of clinicians' views and experiences of direct-acting oral anticoagulants in the management of nonvalvular atrial fibrillation

2018 ◽  
Vol 84 (12) ◽  
pp. 2692-2703 ◽  
Author(s):  
Daria Generalova ◽  
Scott Cunningham ◽  
Stephen J. Leslie ◽  
Gordon F. Rushworth ◽  
Laura McIver ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Systematic Review ◽  
Oral Anticoagulants ◽  
Nonvalvular Atrial Fibrillation ◽  
Direct Acting ◽  
Direct Acting Oral Anticoagulants

scholarly journals The problem of underdosing with direct-acting oral anticoagulants in elderly patients with nonvalvular atrial fibrillation

2020 ◽  
Author(s):  
Carmen Suárez Fernández ◽  
Alejandra Gullón ◽  
Francesc Formiga
Keyword(s):  
Atrial Fibrillation ◽  
Elderly Patients ◽  
Lower Risk ◽  
Vitamin K Antagonists ◽  
Oral Anticoagulants ◽  
Net Benefit ◽  
Nonvalvular Atrial Fibrillation ◽  
Net Clinical Benefit ◽  
Direct Acting ◽  
Direct Acting Oral Anticoagulants

Unless contraindicated, anticoagulant therapy should be prescribed to elderly patients with atrial fibrillation. Direct-acting oral anticoagulants (DOACs) are superior to vitamin K antagonists for preventing stroke. This, together with their higher net clinical benefit, makes DOACs the treatment of choice in this population. However, due to the concerns about bleeding and the need for dose adjustment based on clinical variables, underdosing of DOACs is common and the risk of stroke high. Drugs with more easily adjusted doses are likely associated with a lower risk of dosing errors and, therefore, a greater protective effect. Correct dosing can ensure a maximal net benefit of DOACs in elderly patients with atrial fibrillation.

Impact of weight on the efficacy and safety of direct-acting oral anticoagulants in patients with non-valvular atrial fibrillation: a meta-analysis

EP Europace ◽  
2020 ◽  
Vol 22 (3) ◽  
pp. 361-367 ◽  
Author(s):  
Aaqib H Malik ◽  
Srikanth Yandrapalli ◽  
Suchith Shetty ◽  
Wilbert S Aronow ◽  
Diwakar Jain ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Major Bleeding ◽  
Oral Anticoagulants ◽  
Outcome Data ◽  
Phase Iii ◽  
Safety And Efficacy ◽  
Low Bmi ◽  
Direct Acting ◽  
The Impact ◽  
Direct Acting Oral Anticoagulants

Abstract Aims This study sought to determine the impact of weight and body mass index (BMI) on the safety and efficacy of direct-acting oral anticoagulants (DOACs) compared with warfarin in patients with non-valvular atrial fibrillation. Methods and results A systematic literature search was employed in PubMed, Embase, and Cochrane clinical trials with no language or date restrictions. Randomized trials or their substudies were assessed for relevant outcome data for efficacy that included stroke or systemic embolization (SSE), and safety including major bleeding and all-cause mortality. Binary outcome data and odds ratios from the relevant articles were used to calculate the pooled relative risk. For SSE, the data from the four Phase III trials showed that DOACs are better or similarly effective with low BMI 0.73 (0.56–0.97), normal BMI 0.72 (0.58–0.91), overweight 0.87 (0.76–0.99), and obese 0.87 (0.76–1.00). The risk of major bleeding was also better or similar with DOACs in all BMI subgroups with low BMI 0.62 (0.37–1.05), normal BMI 0.72 (0.58–0.90), overweight 0.83 (0.71–0.96), and obese 0.91 (0.81–1.03). There was no impact on mortality in all the subgroups. In a meta-regression analysis, the effect size advantage of DOACs compared with warfarin in terms of safety and efficacy gradually attenuated with increasing weight. Conclusion Our findings suggest that a weight-based dosage adjustment may be necessary to achieve optimal benefits of DOACs for thromboembolic prevention in these patients with non-valvular atrial fibrillation. Further dedicated trials are needed to confirm these findings. PROSPERO 2019 CRD42019140693. Available from: https://www.crd.york.ac.uk/prospero/display_record.php? ID=CRD42019140693.

scholarly journals Efficacy and Safety of Direct Oral Anticoagulants for Atrial Fibrillation Across Body Mass Index Categories

2020 ◽  
Vol 9 (24) ◽  
Author(s):  
Rachel M. Kaplan ◽  
Yoshihiro Tanaka ◽  
Rod S. Passman ◽  
Michelle Fine ◽  
Laura J. Rasmussen‐Torvik ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Body Mass Index ◽  
Body Mass ◽  
Intracranial Hemorrhage ◽  
Oral Anticoagulants ◽  
Efficacy And Safety ◽  
Class 1 ◽  
Direct Acting ◽  
Direct Acting Oral Anticoagulants

Background Direct‐acting oral anticoagulants are now the preferred method of anticoagulation in patients with atrial fibrillation. Limited data on efficacy and safety of these fixed‐dose regimens are available in severe obesity where drug pharmacokinetics and pharmacodynamics may be altered. The objectives of this study were to evaluate efficacy and safety in patients with atrial fibrillation taking direct‐acting oral anticoagulants across body mass index (BMI) categories in a contemporary, real‐world population. Methods and Results We performed a retrospective study of patients with atrial fibrillation at an integrated multisite healthcare system. Patients receiving a direct‐acting oral anticoagulant prescription and ≥12 months of follow‐up between 2010 and 2017 were included. The primary efficacy and safety outcomes were ischemic stroke or systemic embolism and intracranial hemorrhage. We performed Cox proportional hazards modeling to compute hazard ratios (HRs) adjusted for CHA 2 DS 2 ‐VASc score to examine differences by excess BMI categories relative to normal BMI. Of 7642 patients, mean±SD age was 69±12 years with a median (interquartile range) follow‐up of 3.8 (2.2–6.0) years. Approximately 22% had class 1 obesity and 19% had class 2 or 3 obesity. Stroke risks were similar in patients with and without obesity (HR, 1.2; 95% CI, 0.5–2.9; and HR, 0.68; 95% CI, 0.23–2.0 for class 1 and class 2 or 3 obesity compared with normal BMI, respectively). Risk of intracranial hemorrhage was also similar in class 1 and class 2 or 3 obesity compared with normal BMI (HR, 0.64; 95% CI, 0.35–1.2; and HR, 0.66; 95% CI, 0.35–1.2, respectively). Conclusions Direct‐acting oral anticoagulants demonstrated similar efficacy and safety across all BMI categories, even at high weight values.

Cost-Effectiveness Analysis of Direct-Acting Oral Anticoagulants for Stroke Prevention in Thai Patients with Non-Valvular Atrial Fibrillation and a High Risk of Bleeding

2018 ◽  
Vol 37 (2) ◽  
pp. 279-289 ◽  
Author(s):  
Thananan Rattanachotphanit ◽  
Chulaporn Limwattananon ◽  
Onanong Waleekhachonloet ◽  
Phumtham Limwattananon ◽  
Kittisak Sawanyawisuth
Keyword(s):  
Atrial Fibrillation ◽  
Cost Effectiveness ◽  
High Risk ◽  
Stroke Prevention ◽  
Oral Anticoagulants ◽  
Cost Effectiveness Analysis ◽  
Risk Of Bleeding ◽  
Effectiveness Analysis ◽  
Direct Acting ◽  
Direct Acting Oral Anticoagulants

Direct-Acting Oral Anticoagulants in Atrial Fibrillation

2020 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Filipe Ferrari ◽  
Anderson Donelli da Silveira ◽  
Vitor Magnus Martins ◽  
Leandro Tolfo Franzoni ◽  
Leandro Ioschpe Zimerman ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Oral Anticoagulants ◽  
Direct Acting ◽  
Direct Acting Oral Anticoagulants
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