Clinical use of direct oral anticoagulants in modern practice. Efficiency and safety

2020 ◽  
pp. 26-36
Author(s):  
Elvina Ramisovna Kadyseva ◽  
Albina Zaynutdinovna Nigmedzyanova ◽  
Lyudmila Yurievna Kulagina ◽  
Maksim Leonidovich Maksimov
Keyword(s):  
Mechanism Of Action ◽  
Adverse Reactions ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Clinical Use ◽  
Rational Pharmacotherapy ◽  
Foreign Literature ◽  
Practice Efficiency

The article considers clinical and pharmacological approaches to rational pharmacotherapy with direct oral anticoagulants (DOAC). The main issues of the mechanism of action, pharmacodynamics, and interaction of these medicines, as well as adverse reactions and, consequently, risks associated with taking DOAC, and the principles of selecting direct oral anticoagulants are discussed. The materials are presented on the basis of modern data from domestic and foreign literature.

Contemporary Clinical Use of Aspirin: Mechanisms of Action, Current Concepts, Unresolved Questions, and Future Perspectives

2021 ◽  
Author(s):  
Mikael Christiansen ◽  
Erik Lerkevang Grove ◽  
Anne-Mette Hvas
Keyword(s):  
Cardiovascular Disease ◽  
Clinical Trials ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Bleeding Risk ◽  
Clinical Use ◽  
Action Current ◽  
Potential Clinical Benefit ◽  
Treatment Indications ◽  
Prevention Of Cardiovascular Disease

AbstractThe ability of aspirin to inhibit platelet aggregation has positioned this agent within the most frequently used drugs worldwide. The aim of this article is to review the contemporary clinical use of aspirin and also to discuss unresolved issues not yet translated into clinical practice. Results from several clinical trials have led to strong guideline recommendations for aspirin use in the acute management and secondary prevention of cardiovascular disease. On the contrary, guidelines regarding aspirin use as primary prevention of cardiovascular disease are almost conservative, supported by recent trials reporting that the bleeding risk outweighs the potential benefits in most patients. In pregnancy, aspirin has proved efficient in preventing preeclampsia and small-for-gestational-age births in women at high risk, and is hence widely recommended in clinical guidelines. Despite the vast amount of clinical data on aspirin, several unresolved questions remain. Randomized trials have reported that aspirin reduces the risk of recurrent venous thromboembolism, but the clinical relevance remains limited, because direct oral anticoagulants are more effective. Laboratory studies suggest that a twice-daily dosing regimen or evening intake may lead to more efficient platelet inhibition, and the potential clinical benefit of such strategies is currently being explored in ongoing clinical trials. Enteric-coated formulations of aspirin are frequently used, but it remains unclear if they are safer and as efficient as plain aspirin. In the future, aspirin use after percutaneous coronary interventions might not be mandatory in patients who also need anticoagulant therapy, as several trials support shorter aspirin duration strategies. On the other hand, new treatment indications for aspirin will likely arise, as there is growing evidence that aspirin may reduce the risk of colorectal cancer and other types of cancer.

scholarly journals Prevalence and Resolution of Resistant Left Atrial Appendage Thrombus in Non-Valvular Atrial Fibrillation Patients Submitted to Percutaneous Interventions

2021 ◽  
Vol 4 (8) ◽  
pp. 01-09
Author(s):  
Fabricio Vassallo
Keyword(s):  
Atrial Fibrillation ◽  
Mechanism Of Action ◽  
Complete Resolution ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Atrial Appendage ◽  
Antiplatelet Drug ◽  
Diabetes Diagnosis

Introduction: Left atrial appendage (LAA) thrombus in atrial tachyarrhythmias is one of the principal causes of stroke. Prevalence and strategies to thrombus resolution has recently been described in the era of the direct oral anticoagulants (DOAC). The aim of the study was to determine the prevalence and strategies to resolve previous LAA thrombus during regular oral antithrombotic therapy in preparation to perform atrial fibrillation (AF) ablation and/or LAA closure. Methods: Between January 2011 and December 2020 we prospectively followed 23 patients (5.39%) that showed LAA thrombus formation. Persistent AF occurred in 13 (56.52%), median age 72.39 years, 15 (65.22%) females, median CHA2DS2VASC of 4.13, HASBLED of 2.28, 17 (73.91%) with hypertension, (52.17%) with coronary disease, 9 (39.13%) had priors’ thromboembolic events, 7 (30.43%) with heart failure and Diabetes. Diagnosis was by transesophageal echocardiogram (TEE) in 20 (86.96%) and the rest by computed angiotomography. Rivaroxaban was used in 11 (47.83%), Dabigatran in 6 (26.09%), 5 (21.74%) with therapeutic range Warfarin and 1 (4.34%) with Apixaban. Main strategy of treatment was to change mechanism of action of antithrombotic medication in association to an antiplatelet drug, Clopidogrel 75mg a day, and perform a TEE at 90 days after. Results: Complete resolution of the LAA thrombus was achieved in 18 (78.26%) patients in first medical therapeutic change. Of the remaining a second approach with medical therapy adjustment with off-label dose prescription associated with Clopidogrel showed complete resolution in 3 (13.04%) totalizing a success rate of 91.30% for all patients (p value of 0.001 for treatment success). The failure of the antithrombotic plus antiplatelet therapy occurred in 2 (8.7%) patients, one with LAA sludge and other with a huge thrombus in all LAA and part of left atrium. Conclusion: Modification of the mechanism of action of direct oral anticoagulants in association with Clopidogrel demonstrates to be successful in a large number of patients with previous resistant left atrial thrombus with and secure since the low adverse event rates.

Therapeutics

2020 ◽  
pp. 595-621
Keyword(s):  
Regulatory Agency ◽  
Adverse Reactions ◽  
Oral Anticoagulants ◽  
Information Service ◽  
Healthy Adults ◽  
Dental Practice ◽  
Clinical Use ◽  
Osteonecrosis Of The Jaws ◽  
Medicines Information ◽  
Local Contact

This chapter contains a brief guide to the clinical use of some of the more commonly used and useful drugs in hospital and general dental practice. Doses are for healthy adults. There is also information on prescribing guidelines and adverse reactions which may be encountered. The chapter includes local contact details for the Medicines Information Service as well as details on how to report adverse reactions to drugs to the Medicines and Healthcare products Regulatory Agency (MHRA). Contraindications of common drugs are outlined and updated information on oral anticoagulants and antiplatelets is included, as well as details on medication-related osteonecrosis of the jaws.

Clinical pharmacology technologies for personalization of cardiovascular diseases drug treatment: focus on direct oral anticoagulants

2019 ◽  
Vol 74 (5) ◽  
pp. 299-306
Author(s):  
Dmitry A. Sychev ◽  
Igor N. Sychev ◽  
Karin B. Mirzaev ◽  
Eric I. Rytkin ◽  
Dmitriy V. Ivashchenko ◽  
...  
Keyword(s):  
Clinical Pharmacology ◽  
Cardiovascular Diseases ◽  
Adverse Effects ◽  
Drug Metabolism ◽  
Adverse Reactions ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Drug Reactions ◽  
Treatment Focus ◽  
Cytochrome P 450

One of the main causes for adverse reactions development is not taking into account the pharmacokinetics of drugs and the dose. Pharmacokinetics of drugs is mostly defined by the cytochrome P-450 isoenzymes activity, carboxylesterases and many other isoenzymes of drug metabolism, as well as ADME transporters (P-gp etc.) which take part in the process of drug metabolism. The activity of these isoenzymes is defined by the genetic aspects of patients and non-genetic aspects such as comorbidity and drug-drug interactions. The development of complex algorithms for personalization of therapy based on the results of pharmacogenetic studies and in the form of a decision support system will play an important role in reduction of adverse drug reactions. A lot can be achieved for personalization of Direct Oral Anticoagulants for treatment of cardiovascular diseases. New approaches are being developed based on the results of pharmacogenetic and pharmacokinetic testing that will help diminish adverse effects of drugs.

Direct Oral Anticoagulants

2017 ◽  
Author(s):  
Panna A. Codner ◽  
Michael G Mount
Keyword(s):  
Perioperative Management ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Factor Xa ◽  
Vitamin K Antagonist ◽  
Direct Thrombin Inhibitor ◽  
Thrombin Inhibitor ◽  
Clinical Use ◽  
Nonvalvular Atrial Fibrillation ◽  
Reversal Agents

Non–vitamin K antagonist oral anticoagulants, also known as direct oral anticoagulants, are a relatively recent class of medications introduced into clinical practice. Due to their safety profiles, fixed dosing, and lack of need for frequent laboratory monitoring, they are becoming preferred to traditional anticoagulation with warfarin in many cases of nonvalvular atrial fibrillation and venous thromboembolism. Currently, four drugs are available: dabigatran, a direct thrombin inhibitor, and rivaroxaban, apixaban, and edoxaban, factor Xa inhibitors. This review covers the pharmacology, monitoring, and reversal agents currently available for these medications. The indications for their use are covered through a review of the major clinical trials that led to their US and European approvals for clinical use. Perioperative management of these medications is discussed. Tables list indications, dosing, and monitoring, as well as bleeding risks and efficacy compared with warfarin.  This review contains 1 figure, 11 tables, and 70 references. Key words: apixaban, dabigatran, direct oral anticoagulant, edoxaban, rivaroxaban

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