Comparison Of Drugs in Patients Using New Generation Anticoagulants

2021 ◽  
Vol 6 (14) ◽  
pp. 56-67
Author(s):  
Arslan Say ◽  
Abdülkadir ÇAKMAK ◽  
Gökhan KESKİN ◽  
Erdinç PELİT ◽  
Yılmaz ÖZBAY
Keyword(s):  
Atrial Fibrillation ◽  
Clinical Practice ◽  
Venous Thromboembolism ◽  
Oral Anticoagulants ◽  
Recurrent Venous Thromboembolism ◽  
Anticoagulant Drugs ◽  
History Of ◽  
The Mean ◽  
N 93 ◽  
New Generation

Aim: New generation anticoagulants rapidly find a wider area of use in the clinic due to the use problems of other oral anticoagulants. Anticoagulants such as Dabigatran, Rivaroxaban, and Apixaban with safer treatment intervals have been accepted in clinical practice guidelines and have taken their place as preferred drugs. In this study, we aimed to retrospectively examine the effects of three new-generation anticoagulant drugs on a group of patients. Material and Methods: In this retrospectively planned study, patients diagnosed with atrial fibrillation (n = 522) were divided into three groups according to the drugs used for treatment (Dabigatran, Rivaroxaban, and Apixaban). Routine blood values of the patients in each group were retrospectively scanned according to age, gender, time of drug initiation and presence of chronic disease. Results: According to the results obtained, it was found that the mean HCT, BUN, AST, ALT, MPV, Iron, and Ferritin were higher in patients using Apixaban than those using Dabigatran and Rivaroxaban drugs, but the age, average values of Hgb1 Hgb2, Hgb1, PLT, CrCl, Gfr and INR of the patients using Apixaban lower than those using Dabigatran and Rivaroxaban. The highest rate (22.5%) was found in the group of patients taking apixaban (n=93) when people taking the drugs were examined in terms of mortality. Conclusion: It has been observed that Rivaroxaban can be used more safely in patients with a history of acute cancer and thrombosis, patients with recurrent venous thromboembolism, and patients with high frailty, three drugs should be preferred instead of oral anticoagulants.

Gaps in translation from trials to practice: Non-vitamin K antagonist oral anticoagulants (NOACs) for stroke prevention in atrial fibrillation

2014 ◽  
Vol 111 (05) ◽  
pp. 783-788 ◽  
Author(s):  
Darae Ko ◽  
Christina L. Cove ◽  
Elaine M. Hylek
Keyword(s):  
Atrial Fibrillation ◽  
Clinical Practice ◽  
Vitamin K ◽  
Stroke Prevention ◽  
Current Knowledge ◽  
Oral Anticoagulants ◽  
Vitamin K Antagonist ◽  
Major Advance ◽  
Single Target ◽  
Anticoagulant Drugs

SummaryWorldwide there is a tremendous need for affordable anticoagulants that do not require monitoring. The advent of the non-warfarin oral anticoagulant drugs represents a major advance for stroke prevention in atrial fibrillation (AF). The objectives of this review are to 1) identify gaps in our current knowledge regarding use of these single target anticoagulant drugs; 2) outline the potential implications of these gaps for clinical practice, and thereby, 3) highlight areas of research to further optimise their use for stroke prevention in AF.

Prothrombin Fragment F1+2 Is not Predictive for Recurrent Venous Thromboembolism

1997 ◽  
Vol 77 (05) ◽  
pp. 0829-0833 ◽  
Author(s):  
P A Kyrle ◽  
S Eichinger ◽  
I Pabinger ◽  
A Stümpflen ◽  
M Hirschl ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Venous Thrombosis ◽  
Protein C ◽  
Oral Anticoagulants ◽  
Factor V Leiden ◽  
Factor V ◽  
Recurrent Thrombosis ◽  
Prothrombin Fragment ◽  
Recurrent Venous Thromboembolism ◽  
History Of

SummaryIt would be important to estimate in advance the risk of recurrent thrombosis. Deficiencies of antithrombin, protein C or protein S, or resistance to activated protein C are associated with a biochemically detectable prethrombotic state. It is thus far unknown whether in patients with a history of thromboembolism but without a defined clotting abnormality a heightened coagulation activation is detectable.We investigated the value of prothrombin fragment Fl+2 (FI+2) as a predictor of recurrent venous thromboembolism. Furthermore, we compared the Fl+2 levels of thrombosis patients without a defined clotting defect to those of Factor V Leiden patients with a history of venous thrombosis and to those of healthy controls. 180 patients without a defined clotting abnormality and 73 patients with Factor V Leiden were prospectively followed after discontinuation of oral anticoagulants for venous thrombosis and Fl+2 was measured at regular intervals.Recurrent venous thromboembolism occurred in 23 (9%) of the 253 patients. Before or at several time points after oral anticoagulants, no significant difference in Fl+2 levels was found in patients with and without recurrent thrombosis. Fl+2 levels at 3 weeks and prior to recurrence were not significantly different in both patient groups. Over a one-year observation period, Fl+2 levels of both patients with and without Factor V Leiden were higher than those of the controls. No difference in Fl+2 was seen between patients with and without Factor V Leiden.We conclude that monitoring of Fl+2 is not suitable for identification of individuals at risk of recurrent venous thrombosis. Permanent hemostatic system activation is detectable both in patients with a defined abnormality of the clotting system and in patients in whom a particular defect has not (yet) been identified.

scholarly journals Unprovoked or provoked venous thromboembolism: not the prevalent criterion to decide on anticoagulation extension in clinical practice of various countries—the prospective, international, observational WHITE study

2021 ◽  
Author(s):  
Gualtiero Palareti ◽  
Angelo Bignamini ◽  
Michela Cini ◽  
Young-Jun Li ◽  
Tomasz Urbanek ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Venous Thromboembolism ◽  
Maintenance Treatment ◽  
Present Report ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Treatment Phase ◽  
Index Event ◽  
Anticoagulant Drugs ◽  
Central Database

AbstractThe decision on treatment after a first venous thromboembolism (VTE) to prevent recurrences may be influenced by many factors. The prospective, observational, WHITE study aimed to analyze how this issue was tackled in every-day clinical practice in various countries, which have sensibly different socio-economic conditions and healthcare systems. Doctors active in 79 Internal or Vascular clinical centers in 7 countries (China, Czechia, Poland, Portugal, Russia, Slovakia, and Tunisia) enrolled VTE patients after the maintenance treatment phase. The present report analyzed information, collected in the central database, regarding the baseline characteristics, index events, type and duration of anticoagulant therapy and decision on post-maintenance treatment. From April 2018 to December 2020, 1240 patients were enrolled, 58% with an unprovoked index event. Direct oral anticoagulants (DOACs) were used in > 85% of all cases in China, Poland, Portugal, Russia and Czechia, in 52% in Slovakia and in no patient in Tunisia. The maintenance anticoagulation lasted in average approximately 6 months. Altogether, anticoagulation was stopped in 20%, extended in about 50%, regardless of whether the event was unprovoked or provoked and shifted to antithrombotics (mainly sulodexide or aspirin) in the remaining patients. In conclusion, some differences in VTE patient management were found between countries. The provoked/unprovoked nature of the index event, instead, was not the prevalent criterion to drive the decision on extension of anticoagulation, without large variations between countries. DOACs were the most widely used anticoagulant drugs, whereas > 25% of patients received antithrombotic drugs instead of anticoagulants as extended treatment.

Current and Emerging Direct Oral Anticoagulants: State-of-the-Art

2019 ◽  
Vol 45 (05) ◽  
pp. 490-501 ◽  
Author(s):  
Giuseppe Lippi ◽  
Robert Gosselin ◽  
Emmanuel J. Favaloro
Keyword(s):  
State Of The Art ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Disease Patient ◽  
Factor X ◽  
Anticoagulant Drugs ◽  
History Of ◽  
Heparin Derivatives ◽  
New Generation ◽  
New Onset

AbstractAnticoagulant drugs comprise a specific subcategory of antithrombotic agents that act to inhibit blood coagulation at various stages, reducing clot development and ultimately lowering the risk of developing new-onset or recurrent thrombosis. Although the long history of anticoagulant drugs has been characteristically shaped by coumarin and heparin derivatives, a new generation of direct oral anticoagulants (DOACs), which specifically inhibit thrombin or activated factor X, combine many advantages of their progenitor drugs, and hence are prepotently revolutionizing the landscape of antithrombotic therapy. Several drugs (apixaban [BMS-562247], dabigatran [BIBR953], edoxaban [DU-1766], rivaroxaban [BAY 59–7939]) have already received widespread approval by national or supranational medicinal agencies. This narrative article provides a state-of-the-art for these and for several other DOACs at different stages of clinical evaluation (betrixaban, darexaban, eribaxaban, letaxaban, nokxaban), and certain others whose development has been discontinued (AZD-0837, fidexaban, LY517717, odiparcil, otamixaban, TTP889, and ximelagatran). What clearly emerges from our analysis is that DOACs sharing very similar mechanisms of action are still characterized by different efficacy and safety profiles. This not only depends on biochemical, biological, and pharmacokinetic characteristics, but also on lack of standardization between different clinical trials in terms of targeted disease, patient recruitment, sample size, duration and endpoints, as well as lack of harmonization around procedures used for drug licensing. These factors contribute to challenging the minds of physicians, who may find difficulty navigating their way through multiple indications, different pharmacological profiles, various side effects, and specific drug-to-drug interactions. Such considerations also burden laboratory professionals, who may face organizational and economic challenges in developing and/or implementing multiple assays to assess the pharmacodynamics (effect on coagulation) or pharmacokinetics (drug levels) of DOACs.

scholarly journals Characteristics of Atrial Fibrillation Patients Not Switched from Vka to Noac and Persistence on Vka – a Subgroup Analysis of the Prospective Dresden Noac Registry (NCT01588119)

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 1538-1538
Author(s):  
Jan Beyer-Westendorf ◽  
Franziska Michalski ◽  
Sebastian Werth ◽  
Luise Tittl ◽  
Christina Köhler ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Research Funding ◽  
Vitamin K Antagonists ◽  
Oral Anticoagulants ◽  
Subjective Assessment ◽  
Bleeding Complications ◽  
P Value ◽  
History Of ◽  
The Mean ◽  
Pre Treatment

Abstract Background and Objective: Currently, non-VKA oral anticoagulants (NOAC) are replacing vitamin-K antagonists (VKA) in stroke prevention in atrial fibrillation (SPAF). We evaluated characteristics of SPAF patients that are not switched from VKA to NOACs in daily care. Methods: The prospective Dresden NOAC registry stopped enrolment of dabigatran and rivaroxaban patients on February 28, 2013. At that day, participating sites were asked to enrol all VKA patients seen for regular INR testing who remained on VKA and for whom switching to NOAC was not anticipated. VKA patients were followed for one year. Results: In total, 50 physicians registered both SPAF patients on NOAC-therapy (n=709) and on VKA therapy (n=427; table 1). Compared to the NOAC registry cohort, patients that continued VKA therapy more often were male and less often had a history of TIA/stroke, unstable INR values or a history of bleeding complications compared to the NOAC cohort. The mean duration of VKA pre-treatment was 70.7 months (range 1–432 months). For 328 of the 427 VKA patients (62%), the INR documentation was available for at least 6 months backwards and mean TTR (calculated according to Roosendaal) was 72.2% (SD 19.6). Enrolling sites indicated “stable INR” (95.3%), “costs” (6.3%) and “contraindication for NOAC” (2.3%) as the most common reasons to continue with VKA therapy in these patients. As of June 30th 2014, completed FU correlated to 472.42 patient years. At 12 months-FU (completed in 330 pts.), 311 patients (94.2%) were still taking VKA, 13 patients (3.9%) were switched to other anticoagulants and the remaining 6 patients (1.8%) stopped taking anticoagulants completely. Most common reasons for VKA discontinuation were bleeding complications (7/19; 36.8%) and unstable INR (6/19; 31.6%). Conclusion: NOAC-experienced physicians keep around 40% of anticoagulated SPAF patients on VKA, mostly due to the fact INR is considered to be stable or NOAC to be expensive. The mean TTR of 72% indicates that subjective assessment of INR stability is accurate. Patients with a history of stroke or bleeding complications are more likely to be switched from VKA to NOAC. During the following 12 months, less than 6% of the VKA continuers need to stop VKA treatment, indicating that the subjective assessment of the attending physician identifies patients with acceptable VKA treatment persistence. Table 1: characteristics of 1136 patients selected for VKA continuation (n=427), switch to NOAC (n=291) or new start of NOAC (n=418) in 50 private practises enrolling both VKA and NOAC patients into the registry All patientsn=1136 VKAn=427 Switch VKA to NOACn=291 NOAC newn=418 p-value Male, n (%) 52.82 59.02 50.17 48.33 0.0045 Age, years(median; 25th;75th percentile) 75 (70; 80) 74 (70; 79) 75 (70;81) 76 (70;82) 0.210 Mean BMI ± SD (kg/m2) 28.7 ± 4.9 28.68 ± 4.9 29.06 ± 4.9 28.46 ± 4.9 0.272 Chronic heart failure, (%) 41.29 43.56 43.3 37.56 0.149 Arterial hypertension, (%) 88.56 91.8 84.88 87.8 0.013 Diabetes,(%) 41.73 43.33 43.99 38.52 0.244 Coronary artery disease,(%) 23.06 23.65 22.34 22.97 0.916 Prior stroke or systemic embolism,(%) 13.47 8.9 17.53 15.31 0.001 History of bleeding complications (%) 3.79 0.7 7.56 4.31 <0.001 History of unstable INR 7.39 0.7 26.46 n.a. <0.001 Disclosures Beyer-Westendorf: Bayer: Honoraria, Research Funding; Pfizer: Honoraria, Research Funding; Boehringer Ingelheim: Honoraria, Research Funding. Werth:Bayer: Honoraria. Köhler:Bayer: Honoraria. Weiss:Boehringer Ingelheim: Honoraria; Bayer: Honoraria.

P2770Clinical characteristics and outcomes of venous thromboembolism according to patients with versus without atrial fibrillation: from the COMMAND VTE Registry

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M Oi ◽  
Y Yamashita ◽  
T Morimoto ◽  
H Amano ◽  
T Takase ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Venous Thromboembolism ◽  
Major Bleeding ◽  
Clinical Characteristics ◽  
Oral Anticoagulants ◽  
Management Strategies ◽  
Anticoagulation Therapy ◽  
History Of ◽  
Study Population ◽  
Recurrent Vte

Abstract Background/Introduction Oral anticoagulants are widely used for the treatment and second prevention of venous thromboembolism (VTE) and stroke prevention in atrial fibrillation (AF). VTE and AF are common diseases and these sometimes might coexist. However, there are few reports about the relationship between VTE and AF. Purpose We sought to evaluate the clinical characteristics and outcomes in VTE patients with AF. Methods The COMMAND VTE Registry is a multicenter registry enrolling consecutive 3027 patients with acute symptomatic VTE objectively confirmed by imaging examination or by autopsy among 29 centers in Japan between January 2010 and August 2014. The current study population consisted of 129 patients with AF (AF group) and 2898 patients without AF (non-AF group). We compared the clinical characteristics, management strategies and long-term outcomes between the 2 groups. Results The AF group was older (mean age: 75.3 vs. 66.8 years, P<0.001), and more often had co-morbidities such as hypertension (54.3% vs. 37.7%, P<0.001), diabetes mellitus (20.2% vs. 12.4%, P=0.01), chronic kidney disease (28.7% vs. 18.5%, P=0.004), heart failure (28.7% vs. 18.5%, P=0.004), history of stroke (20.2% vs. 8.4%, P<0.001), and history of major bleeding (12.4% vs. 7.4%, P=0.04) compared with the non-AF group, whereas there were no significant differences in the proportions of active cancer at diagnosis (18.6% vs. 23.2%, P=0.23) and pulmonary embolism at presentation (64.3% vs. 56.3%, P=0.07). The proportion of anticoagulation therapy beyond acute phase was not significantly different (94% vs. 93%, P=0.60), while the cumulative discontinuation rates of anticoagulation therapy was significantly lower in the AF group (26.9% vs. 43.4% at 3 years, Log-rank P=0.03). The cumulative 5-year incidences of recurrent VTE and major bleeding were not significantly different (Recurrent VTE: 7.6% vs. 10.6%, Log-rank P=0.89; Major bleeding: 18.6% vs. 11.8%, Log-rank P=0.07). After adjusting for potential confounders, the risks of the AF group relative to the non-AF group for recurrent VTE and major bleeding remained insignificant (HR 1.19, 95% CI 0.54–2.28, P=0.64; HR 1.28, 95% CI 0.73–2.06, P=0.37). The cumulative 5-year incidence of all-cause death was significantly higher in the AF-group (49.1% vs. 28.6%, Log-rank P<0.001). After adjusting for potential confounders, the risks of the AF group relative to the non-AF group for all-cause death remained significant (HR 1.63, 95% CI 1.23–2.15, P<0.001). The proportion of deaths due to cancer was lower in the AF group (30% vs. 55%, P<0.001), while the proportion of cardiac deaths was higher in the AF group (16.1% vs. 4.0%, P<0.001). The outcomes of VTE patients with AF Conclusions The risks for recurrent VTE between patients with AF and those without AF were not significantly different, although patients with AF received longer-term anticoagulation therapy, whereas the risks for major bleeding tended to be higher in patients with AF. Acknowledgement/Funding Research Institute for Production Development, Mitsubishi Tanabe Pharma Corporation

Edoxaban treatment of elderly patients with atrial fibrillation in routine clinical practice: 1-year results of the non-interventional Global ETNA-AF program

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
T Yamashita ◽  
C.C Wang ◽  
Y.-H Kim ◽  
R De Caterina ◽  
P Kirchhof ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Clinical Practice ◽  
Major Bleeding ◽  
Intracranial Haemorrhage ◽  
Clinical Care ◽  
Oral Anticoagulants ◽  
Clinical Event ◽  
Funding Source ◽  
Private Company ◽  
All Cause Mortality

Abstract Background The prevalence of atrial fibrillation (AF) and the need for appropriate anticoagulation increase with age. The benefit/risk profile of direct oral anticoagulants such as edoxaban in elderly population with AF in regular clinical practice is therefore of particular interest. Purpose Analyses of Global ETNA-AF data were performed to report patient characteristics, edoxaban treatment, and 1-year clinical events by age subgroups. Methods Global ETNA-AF is a multicentre, prospective, noninterventional program conducted in Europe, Japan, Korea, Taiwan, and other Asian countries. Demographics, baseline characteristics, and 1-year clinical event data were analysed in four age subgroups. Results Of 26,823 patients included in this analysis, 50.4% were ≥75 years old and 11.6% were ≥85 years. Increase in age was generally associated with lower body weight, lower creatinine clearance, higher CHA2DS2-VASc and HAS-BLED scores, and a higher percentage of patients receiving the reduced dose of 30 mg daily edoxaban. At 1-year, rates of ISTH major bleeding and ischaemic stroke were generally low across all age subgroups. The proportion of intracranial haemorrhage within major bleeding events was similar across age groups. All-cause mortality increased with age more than cardiovascular mortality. Conclusion Data from Global ETNA-AF support the safety and effectiveness of edoxaban in elderly AF patients (including ≥85 years) in routine clinical care with only a small increase in intracranial haemorrhage. The higher all-cause mortality with increasing age is not driven by cardiovascular causes. Funding Acknowledgement Type of funding source: Private company. Main funding source(s): Daiichi Sankyo

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