Direct Acting Oral Anticoagulants in electrotherapy

2018 ◽  
Vol 3 (48) ◽  
pp. 12-16
Author(s):  
Przemysław Mitkowski ◽  
Romuald Ochotny
Keyword(s):  
Vitamin K Antagonists ◽  
Oral Anticoagulants ◽  
Electronic Devices ◽  
Bleeding Event ◽  
Bleeding Risk ◽  
Cardiac Implantable Electronic Devices ◽  
Number Of Patients ◽  
High Bleeding Risk ◽  
Direct Acting ◽  
Direct Acting Oral Anticoagulants

Direct Acting Oral Anticoagulants (DOAC) since last 9 years catch on medical treatment and number of patients who receive them forced guidelines on its usage in high bleeding risk circumstances including ablation and cardiac implantable electronic devices (CIED) procedures. In current paper the available publications and guidelines in this field were discussed. In VENTURE-AF, RE-CIRCUIT and AXAFA-AFNET 5 trials safety of uninterrupted DOAC therapy during ablation procedure were confirmed. All patient during procedure received additional unfractionated heparine (UFH) to obtain value of ACT > 300 s. Bleeding event rate was comparable in patients treated with DOAC and those on vitamin K antagonists (VKA), and even lower when patients were on dabigatran. In BRUISE CONTROL 2 trial, in which patients undergoing CIED implantation were enrolled, no statistically significant differences in effectiveness and safety between uninterrupted and interrupted periprocedural DOAC treatment were noticed.

P1897Prescription of guideline recommended oral anticoagulation and reasons reported for non-use of OAC in patients with atrial fibrillation: Data from the German AFNET-2 Registry

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M Naebauer ◽  
A Gerth ◽  
G Steinbeck ◽  
K Wegscheider ◽  
P Kirchhof ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Antiplatelet Therapy ◽  
Oral Anticoagulation ◽  
Vitamin K Antagonists ◽  
Bleeding Event ◽  
Bleeding Risk ◽  
Number Of Patients ◽  
Study Population ◽  
High Bleeding Risk ◽  
Prior Stroke

Abstract Background Oral anticoagulation (OAC) reduces thromboembolic events and mortality in patients with atrial fibrillation (AF). Anticoagulation rates have substantially increased over recent years. Still, a number of patients are not receiving guideline recommended OAC. Purpose To investigate clinical factors and reasoning associated with non-prescription of OAC in a current German registry. Methods The German AFNET 2 registry is a prospective multi-center registry on atrial fibrillation comprising a total of 3491 patients from all levels of medical care (general practitioners, cardiologists, hospitals; enrolment 5/2014 to 3/2016). The registry was conducted in collaboration with the EORP program of the ESC. Here, only patients with non-valvular AF and at least two clinical risk factors for stroke (using CHA2DS2-VASc score) were considered. Results The study population consisted of 2856 patients, 58.4% male, mean age 75.5±7.8 years, mean CHA2DS2-VASc score 4.1±1.5, mean HAS-BLED score 1.8±1.0. Overall, the rate of OAC was 94.3%. 54% of these received Vitamin K antagonists (VKA) and 46% NOAC. 2.3% received antiplatelets only. Patients newly initiated on OAC mostly received a NOAC (82.5% of patients). Anticoagulation rate was lower in elderly patients (age <80 years: 95.0%, age ≥80 years 92.8%, p<0.05). No difference in OAC was seen between men and women (94.1% and 94.6%, respectively). Patients with high bleeding risk (HAS-BLED ≥3) received significantly less OAC than patients at low bleeding risk (95.3 vs 90.6%, p<0.001). Patients on antiplatelet therapy received OAC in only 78.0% compared to patients without antiplatelet therapy in 96.6% (p<0.001). In patients without OAC (n=162 patients), reasons stated for non-prescription of OAC were patient's unwillingness to take OAC (13.6%), physician preference (12.3%), prior bleeding event (10.5%), renal dysfunction (8.6%), frequent falls (5.6%), current anaemia (5.6%), current operation/intervention (4.9%), current bridging with LMW heparin (4.9%), and other reasons (9.3%). Using logistic regression analysis, non-prescription of OAC was strongly associated with antiplatelet therapy (HR=0.082), anaemia (HR=0.41), dementia (HR=0.37), and previous extra- (HR=0.2) or intracranial haemorrhage (HR=0.35). Predictors of OAC use were prior stroke/embolism (HR=2.35), hypertension (HR=2.23), heart failure (HR=1.51), and previous stent implantation (HR=2.12). When considered as a score, a HAS-BLED score ≥3 was strongly associated with non-prescription of OAC (HR=0.51). Conclusions Within registries, the guideline recommended use of OAC is very high in Germany indicating high guideline adherence by prescribing physicians. However, use of antiplatelet therapy was associated with non-prescription of OAC. In addition, a high HAS-BLED score appears to be a relevant argument for withholding proven OAC for stroke prevention in patients with AF. Acknowledgement/Funding BMS Germany; DZHK

scholarly journals Terapia antitrombótica en pacientes con hemorragia intracraneal. ¿Revertimos?

2018 ◽  
Vol 10 (8) ◽  
pp. 6
Author(s):  
Jose Vicente Catalá Ripoll ◽  
Jose Ángel Monsalve Naharro ◽  
Esther Domingo Chiva ◽  
Pablo Cuesta Montero ◽  
Jose María Jiménez Vizuete
Keyword(s):  
Molecular Weight ◽  
Clinical Practice ◽  
Intracranial Hemorrhage ◽  
Vitamin K Antagonists ◽  
Oral Anticoagulants ◽  
Fibrinolytic Therapy ◽  
Low Molecular Weight ◽  
Low Molecular Weight Heparins ◽  
Direct Acting ◽  
Direct Acting Oral Anticoagulants

Realizamos una revisión de la guía de práctica clínica de la reversión de la terapia antitrombótica en pacientes con hemorragia intracraneal que hayan recibido terapia antiagregante, anticoagulante o fibrinolítica. Se analizan recomendaciones para la reversión de antagonistas de vitamina K, anticoagulantes orales de acción directa, heparinas no fraccionadas y de bajo peso molecular, trombolíticos y antiagregantes plaquetarios, en el contexto de una hemorragia intracraneal.  ABSTRACT Review the clinical practice guidelines for the reversal of antithrombotic therapy in patients with intracranial hemorrhage with antiplatelet, anticoagulant or fibrinolytic therapy. We analyzed the most important recommendations for the reversal of vitamin K antagonists, direct-acting oral anticoagulants, unfractionated and low-molecular-weight heparins, thrombolytics and platelet antiaggregants, in the context of an intracranial hemorrhage.

scholarly journals Thrombotic and Bleeding Outcomes Following Perioperative Interruption of Direct Oral Anticoagulants and Vitamin K Antagonists in Patients with Non-Valvular Atrial Fibrillation - a Comparative Analysis

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 1234-1234
Author(s):  
Joseph R. Shaw ◽  
Tinghua Zhang ◽  
Gregoire Le Gal ◽  
James Douketis ◽  
Marc Carrier
Keyword(s):  
Major Bleeding ◽  
Research Funding ◽  
Vitamin K Antagonists ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Bleeding Risk ◽  
Advisory Board ◽  
Bleeding Events ◽  
Chads2 Score ◽  
High Bleeding Risk

Abstract Background: Atrial fibrillation (AF) is a common disorder that will affect up to 5.6 million patients in the U.S. by 2050. Both direct oral anticoagulants (DOACs) and vitamin K antagonists (VKAs), typically warfarin, are used for stroke prevention in AF and such patients frequently undergo invasive procedures requiring anticoagulant interruption. Temporary interruption of anticoagulants can be associated with significant morbidity and mortality in the form of thromboembolic and bleeding complications. DOACs have a short half-life and fast onset of action, thereby facilitating their perioperative management as compared to VKAs. Despite important differences in perioperative management and pharmacokinetics between DOACs and VKAs, there is a paucity of data comparing perioperative outcomes in DOAC and VKA-treated patients. Methods: We undertook a single-center, retrospective chart review that compared consecutive DOAC- or warfarin-treated patients with AF who underwent perioperative anticoagulant interruption for invasive procedures between January 2017 and March 2018. Perioperative warfarin interruption was done as per CHEST guidelines (Douketis et al. Chest 141,2 Suppl). Perioperative bridging with low-molecular-weight heparin was only used for patients with CHADS2 scores of 5-6 or in patients with stroke within the past 6 months. Perioperative interruption of DOACs was done as per Thrombosis Canada guidelines, with anticoagulation held for 3 half-lives prior to low bleeding risk procedures and 5 half-lives for high bleeding risk procedures. Primary outcomes included the 30-day post-operative thromboembolic and major bleeding rates. Secondary outcomes included the 30-day clinically relevant non-major bleeding (CRNMB) andl mortality rates. Major bleeding and CRNMB were defined according to ISTH definitions. Procedural bleeding risk was defined as per Schulman et al (Circulation 2015; 132(3)). Outcome events were independently adjudicated by two investigators. Outcomes from patients on DOACs and VKAs were compared. Demographic data was analyzed on a per-patient basis, p-values were calculated using independent T-Test, Chi-Square/Fisher's Exact Test where appropriate. Outcome data was analyzed on a per-interruption basis. P-values for unadjusted and adjusted comparisons were calculated using generalized estimating equations (GEE) to account for correlation between multiple procedures on the same patients. Results: 325 DOAC patients and 199 warfarin patients underwent 351 and 221 periprocedural interruptions, respectively. Warfarin patients had a significantly higher mean age, CHADS2 score, and proportion with renal dysfunction (Table 1). There was no statistically significant difference in 30-day post-operative rates of thromboembolism, CRNMB, and overall mortality, but warfarin patients had a significantly higher rate of major bleeding (Table 2). This latter result remained statistically significant following multivariate logistic regression correction for age, CHADS2 score and level of renal dysfunction. All bleeding events occurred post-procedure, with major bleeding events occurring from post-operative day 1 to post-operative day 25. None of the warfarin patients with major bleeding received perioperative bridging; the mean international normalized ratio (INR) at the time of major bleeding was 3.3. Most major bleeding events (7/8) in the VKA arm were surgical, with a single non-surgical major-bleed (spontaneous ICH on post-operative day 15 following urological surgery). Conclusions: The perioperative interruption of warfarin was associated with a higher 30-day rate of major bleeding as compared with DOAC interruption. Re-initiation of warfarin should be done judiciously following high bleeding risk procedures, and close INR monitoring may be warranted. Disclosures Shaw: Portola Pharmaceuticals: Research Funding. Douketis:Janssen: Consultancy; Pfizer: Other: Advisory Board; Boehringer-Ingelheim: Consultancy, Other: Advisory Board, Research Funding; Portola: Other: Advisory Board; The Medicines Company: Other: Advisory Board; Daiichi-Sankyo: Other: Advisory Board; Biotie: Other: Advisory Board; Bayer: Other: Advisory Board; Sanofi: Consultancy, Other: Advisory Board; BMS: Other: Advisory Board; Astra-Zeneca: Other: Advisory Board. Carrier:Bayer: Honoraria; Pfizer: Honoraria; BMS: Honoraria, Research Funding; Leo Pharma: Research Funding.

scholarly journals Thromboembolism in Older Adults

2021 ◽  
Vol 7 ◽  
Author(s):  
Peter L. Gross ◽  
Noel C. Chan
Keyword(s):  
Older Adults ◽  
Venous Thromboembolism ◽  
Vitamin K ◽  
Older Patients ◽  
Vitamin K Antagonists ◽  
Oral Anticoagulants ◽  
Very Elderly ◽  
Direct Acting ◽  
Risk And Benefit ◽  
Direct Acting Oral Anticoagulants

Arterial and venous thromboembolism are both more common in older adults. The use of anticoagulants, the mainstay to prevent thromboembolism, requires consideration of the balance between risk and benefit. Such consideration is even more important in the very elderly in whom the risk of anticoagulant-related bleeding and thrombosis are higher. This review will focus on the challenges of implementing and managing anticoagulant therapy in older patients in an era when the options for anticoagulants include not only vitamin K antagonists (VKAs), but also direct-acting oral anticoagulants (DOACs).

The NOACs: pharmacodynamics and pharmacokinetics

ESC CardioMed ◽  
2018 ◽  
pp. 264-268
Author(s):  
Thomas Vanassche ◽  
Peter Verhamme
Keyword(s):  
Vitamin K ◽  
Vitamin K Antagonists ◽  
Oral Anticoagulants ◽  
Drug Dose ◽  
Vitamin K Antagonist ◽  
Fixed Dose ◽  
Routine Monitoring ◽  
Pharmacokinetic Properties ◽  
Direct Acting ◽  
Direct Acting Oral Anticoagulants

The non-vitamin K antagonist oral anticoagulants (NOACs) (or direct-acting oral anticoagulants) are a novel class of direct-acting oral anticoagulants developed to offer more predictable pharmacodynamic and pharmacokinetic properties compared to vitamin K antagonists. Due to their predictable relation between drug dose and anticoagulant effect, NOACs are used at a fixed dose, without routine monitoring of coagulation parameters. While the use of a fixed dose greatly enhances the convenience of anticoagulant therapy, physicians need to understand the pharmacokinetic and pharmacodynamic aspects of NOACs to identify those patients for whom a dosage adjustment is required.

MHRA DOAC safety reminder

2020 ◽  
Vol 58 (10) ◽  
pp. 150-150
Keyword(s):  
Drug Safety ◽  
Regulatory Agency ◽  
Oral Anticoagulants ◽  
Bleeding Risk ◽  
Reversal Agents ◽  
Direct Acting ◽  
Direct Acting Oral Anticoagulants

AbstractReview of: Medicines and Healthcare products Regulatory Agency. Direct-acting oral anticoagulants (DOACs): reminder of bleeding risk, including availability of reversal agents. Drug Safety Update 2020;13(11):1

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