scholarly journals Risk of cerebral haemorrhage in patients treated with antithrombotic drugs. Focus on new oral anticoaguants

2011 ◽  
Vol 2 (1S) ◽  
pp. 77
Author(s):  
Giancarlo Agnelli
Keyword(s):  
Clinical Practice ◽  
Vitamin K ◽  
Cardiovascular Events ◽  
Vitamin K Antagonists ◽  
Oral Anticoagulants ◽  
Cerebral Haemorrhage ◽  
Antithrombotic Drugs ◽  
Thromboembolic Risk ◽  
Prevention And Treatment ◽  
Antithrombotic Efficacy

Antithrombotic drugs represent one of the leading pharmacological category used in clinical practice, especially in cardiovascular setting. Their demonstrated antithrombotic efficacy has been fundamental in the improvement of the management of many diseases related to athero-thrombotic or thromboembolic risk in prevention and treatment of cardiovascular events. Nonetheless, they are also associated with a not negligible haemorrhagic risk. Among these risks, intracranial bleeding represents the most feared, and should be kept in mind, prevented when possible and adequately managed when occurs. In this article the intracranial haemorrhagic risk associated to drugs vitamin K antagonists and new oral anticoagulants is reviewed.

scholarly journals Risk of cerebral haemorrhage in patients treated with antithrombotic drugs. Focus on new oral anticoaguants

2011 ◽  
Vol 2 (1S) ◽  
pp. 77-86
Author(s):  
Giancarlo Agnelli
Keyword(s):  
Clinical Practice ◽  
Vitamin K ◽  
Cardiovascular Events ◽  
Vitamin K Antagonists ◽  
Oral Anticoagulants ◽  
Cerebral Haemorrhage ◽  
Antithrombotic Drugs ◽  
Thromboembolic Risk ◽  
Prevention And Treatment ◽  
Antithrombotic Efficacy

Antithrombotic drugs represent one of the leading pharmacological category used in clinical practice, especially in cardiovascular setting. Their demonstrated antithrombotic efficacy has been fundamental in the improvement of the management of many diseases related to athero-thrombotic or thromboembolic risk in prevention and treatment of cardiovascular events. Nonetheless, they are also associated with a not negligible haemorrhagic risk. Among these risks, intracranial bleeding represents the most feared, and should be kept in mind, prevented when possible and adequately managed when occurs. In this article the intracranial haemorrhagic risk associated to drugs vitamin K antagonists and new oral anticoagulants is reviewed.

scholarly journals Anticoagulation in Atrial Fibrillation Cardioversion: What Is Crucial to Take into Account

2021 ◽  
Vol 10 (15) ◽  
pp. 3212
Author(s):  
Fabiana Lucà ◽  
Simona Giubilato ◽  
Stefania Angela Di Fusco ◽  
Laura Piccioni ◽  
Carmelo Massimiliano Rao ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Vitamin K ◽  
Thrombus Formation ◽  
Vitamin K Antagonists ◽  
Oral Anticoagulants ◽  
Anticoagulation Therapy ◽  
Significant Advance ◽  
Thromboembolic Events ◽  
Thromboembolic Risk ◽  
Pharmacological Cardioversion

The therapeutic dilemma between rhythm and rate control in the management of atrial fibrillation (AF) is still unresolved and electrical or pharmacological cardioversion (CV) frequently represents a useful strategy. The most recent guidelines recommend anticoagulation according to individual thromboembolic risk. Vitamin K antagonists (VKAs) have been routinely used to prevent thromboembolic events. Non-vitamin K antagonist oral anticoagulants (NOACs) represent a significant advance due to their more predictable therapeutic effect and more favorable hemorrhagic risk profile. In hemodynamically unstable patients, an emergency electrical cardioversion (ECV) must be performed. In this situation, intravenous heparin or low molecular weight heparin (LMWH) should be administered before CV. In patients with AF occurring within less than 48 h, synchronized direct ECV should be the elective procedure, as it restores sinus rhythm quicker and more successfully than pharmacological cardioversion (PCV) and is associated with shorter length of hospitalization. Patients with acute onset AF were traditionally considered at lower risk of thromboembolic events due to the shorter time for atrial thrombus formation. In patients with hemodynamic stability and AF for more than 48 h, an ECV should be planned after at least 3 weeks of anticoagulation therapy. Alternatively, transesophageal echocardiography (TEE) to rule out left atrial appendage thrombus (LAAT) should be performed, followed by ECV and anticoagulation for at least 4 weeks. Theoretically, the standardized use of TEE before CV allows a better stratification of thromboembolic risk, although data available to date are not univocal.

scholarly journals Anticoagulation for Atrial Fibrillation: Is This the End of Warfarin? Not Just Yet

2013 ◽  
Vol 2013 ◽  
pp. 1-7 ◽  
Author(s):  
Michael Mallouppas ◽  
Vassilios Vassiliou
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Cardiac Arrhythmia ◽  
Vitamin K ◽  
Vitamin K Antagonists ◽  
Oral Anticoagulants ◽  
Significant Risk ◽  
Thromboembolic Risk ◽  
Risk Increase ◽  
Rate Limiting

Atrial fibrillation (AF) is the most common cardiac arrhythmia. Its prevalence is known to increase with age and with an aging population AF is likely to become even more common. Although sometimes patients with AF remain asymptomatic, it is now recognized that AF is far from “benign” conferring a significant risk increase in morbidity and mortality. Restoration of sinus rhythm and rate-limiting medication help with symptoms; however, anticoagulation remains essential in reducing thromboembolic risk. The uptake of appropriate anticoagulation with vitamin K antagonists has increased significantly in the last few decades and this review will analyze whether the new oral anticoagulants might prove to be even more effective than existing vitamin K antagonists.

scholarly journals Non-vitamin K Antagonist Oral Anticoagulants and Drug-Food Interactions: Implications for Clinical Practice and Potential Role of Probiotics and Prebiotics

2022 ◽  
Vol 8 ◽  
Author(s):  
Ana Sánchez-Fuentes ◽  
José Miguel Rivera-Caravaca ◽  
Raquel López-Gálvez ◽  
Francisco Marín ◽  
Vanessa Roldán
Keyword(s):  
Clinical Practice ◽  
Vitamin K ◽  
Potential Role ◽  
Therapeutic Option ◽  
Vitamin K Antagonists ◽  
Oral Anticoagulants ◽  
Vitamin K Antagonist ◽  
Pharmacodynamic Profile ◽  
Potential Interactions

Non-vitamin K antagonist oral anticoagulants (NOACs) are a therapeutic option to prevent stroke in patients with atrial fibrillation (AF). In fact, NOACs have become the recommended choice by international clinical practice guidelines over vitamin K antagonists (VKA), because of their efficacy and safety profile, especially in newly initiated patients. The more predictable pharmacokinetic and pharmacodynamic profile of this family of drugs allows preventing anticoagulation drug monitoring. Furthermore, NOACs have significantly fewer drug and food interactions in comparison with VKAs. Despite this, there are no studies that compare the effects on the quality of anticoagulation of NOACs with the intake of potential interactions drugs of P-glycoprotein and cytochrome P450 (CYP). This review brings an overview of NOACs pharmacokinetics profile and their potential drug-food interactions. We also briefly discuss the potential role of prebiotics and probiotics in patients under therapy with NOACs.

Voorkamerfibrillatie en niet-vitamine K-antagonist orale anticoagulantia: van klinische studies tot gebruik in de dagelijkse praktijk

2021 ◽  
Author(s):  
A. CAPIAU ◽  
M. GRYMONPREZ ◽  
T. DE BACKER ◽  
S. GEVAERT ◽  
K. BOUSSERY ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Clinical Practice ◽  
Vitamin K ◽  
Vitamin K Antagonists ◽  
Oral Anticoagulants ◽  
Anticoagulation Therapy ◽  
Real Life ◽  
Vitamin K Antagonist ◽  
Fixed Dose ◽  
Stroke Risk Factor

Atrial fibrillation and non-vitamin K antagonist oral anticoagulants: from clinical trials to real-world clinical practice. For decades, vitamin K antagonists (VKAs) were the only oral anticoagulants available for the prevention of thromboembolism in patients with atrial fibrillation (AF). Since 2012, non-vitamin K antagonist oral anticoagulants (NOACs) are available for this indication, which have proven to be at least as effective and safe as VKAs in randomized controlled trials (RCTs). NOACs have additional benefits, such as a fast onset of action, a fixed-dose regimen without requiring regular monitoring, less interactions and less intracranial bleeding. Their emergence has caused a paradigm shift in anticoagulation therapy, with NOACs being the anticoagulant of choice compared to VKAs. Since strict in- and exclusion criteria were used in the pivotal RCTs, concerns have risen regarding the generalizability of these results to real-life clinical practice in patients with multiple comorbidities. In this manuscript, this extrapolation is discussed, focusing on 4 different topics regarding appropriate NOAC use: the management of AF patients with a single stroke risk factor, the importance of an optimal therapy adherence, potential drug-drug interactions with NOACs and addressing a geriatric AF patient after a fall. Hopefully, this manuscript will help guide clinicians in the optimal use of NOACs in their daily clinical practice.

Anticoagulation beyond direct thrombin and factor Xa inhibitors: indications for targeting the intrinsic pathway?

2013 ◽  
Vol 110 (08) ◽  
pp. 223-232 ◽  
Author(s):  
Maurits van Montfoort ◽  
Joost Meijers
Keyword(s):  
Vitamin K ◽  
Vitamin K Antagonists ◽  
Oral Anticoagulants ◽  
Factor Xa ◽  
Coagulation Factor ◽  
Coagulation Factors ◽  
Factor Xa Inhibitors ◽  
Therapeutic Window ◽  
Intrinsic Pathway ◽  
Antithrombotic Drugs

SummaryAntithrombotic drugs like vitamin K antagonists and heparin have been the gold standard for the treatment and prevention of thromboembolic disease for many years. Unfortunately, there are several disadvantages of these antithrombotic drugs: they are accompanied by serious bleeding problems, it is necessary to monitor the therapeutic window, and there are various interactions with food and other drugs. This has led to the development of new oral anticoagulants, specifically inhibiting either thrombin or factor Xa. In terms of effectiveness, these drugs are comparable to the currently available anticoagulants; however, they are still associated with issues such as bleeding, reversal of the drug and complicated laboratory monitoring. Vitamin K antagonists, heparin, direct thrombin and factor Xa inhibitors have in common that they target key proteins of the haemostatic system. In an attempt to overcome these difficulties we investigated whether the intrinsic coagulation factors (VIII, IX, XI, XII, prekallikrein and high-molecular-weight kininogen) are superior targets for anticoagulation. We analysed epidemiological data concerning thrombosis and bleeding in patients deficient in one of the intrinsic pathway proteins. Furthermore, we discuss several thrombotic models in intrinsic coagulation factor-deficient animals. The combined results suggest that intrinsic coagulation factors could be suitable targets for anticoagulant drugs.

Benefit–risk profile of non-vitamin K antagonist oral anticoagulants in the management of venous thromboembolism

2015 ◽  
Vol 113 (02) ◽  
pp. 231-246 ◽  
Author(s):  
Walter Ageno ◽  
Jan Beyer-Westendorf
Keyword(s):  
Venous Thromboembolism ◽  
Vitamin K ◽  
Vitamin K Antagonists ◽  
Oral Anticoagulants ◽  
Risk Groups ◽  
Phase Iii ◽  
Thrombin Inhibitor ◽  
Wound Complications ◽  
Orthopaedic Patients ◽  
Prevention And Treatment

SummaryThe prevention and treatment of venous thromboembolism (VTE) remains a clinical challenge, primarily owing to drawbacks associated with the use of heparins and vitamin K antagonists (VKAs). These and other factors, including a growing elderly population, mean that VTE presents a continuing burden to patients and physicians. Anticoagulant therapy is a fundamental approach for VTE management. Non- VKA oral anticoagulants, including the factor Xa inhibitors apixaban, edoxaban and rivaroxaban, and the thrombin inhibitor dabigatran, have been studied in phase III trials across a spectrum of thromboembolic disorders. These agents offer simplified care, with similar or improved efficacy and safety outcomes compared with heparins and vitamin K antagonists. There are several factors a physician must consider when prescribing an anticoagulant. An important consideration with all anticoagulant use is bleeding risk, especially in high-risk groups such as the elderly or those with renal impairment or cancer. In orthopaedic patients, other risks include a need for surgical revision or blood transfusion, or wound complications. Therefore, the clinical benefits of an anticoagulant should ideally be balanced with any risks associated with the therapy. Quantitative benefit–risk assessments are lacking, and owing to differences in trial design the non-VKA oral anticoagulants cannot be compared directly. Based on trial and “reallife” data, this review will summarise the clinical data for the non-VKA oral anticoagulants in the prevention and treatment of VTE, focusing on the balance between the benefits and risks of anticoagulation with these drugs, and their potential impact on VTE management.

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