scholarly journals Treatment of very old patients with non valvular atrial fibrillation. The valuable opportunity offered by New Oral Anticoagulants, to be cautiously used

2013 ◽  
Vol 80 (4) ◽  
Author(s):  
Francesco Orso ◽  
Riccardo Barucci ◽  
Stefania Fracchia ◽  
Giulio Mannarino ◽  
Alessandra Pratesi ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Oral Anticoagulant Therapy ◽  
Oldest Old ◽  
Oral Anticoagulants ◽  
New Oral Anticoagulants ◽  
High Rate ◽  
Thrombin Inhibitor ◽  
Thromboembolic Events ◽  
Anthropometric Measures ◽  
Old Patients

Atrial Fibrillation (AF) is the most frequent cardiac arrhythmia and its incidence increases with age reaching a 10% prevalence in the oldest old. Patients with AF have a five-fold increase in the risk of stroke. Current guidelines on AF management recommend the prescription of oral anticoagulant therapy in patients at medium and high risk of thromboembolic events. Advanced age is a risk factor for stroke in AF, but despite clear evidences a high rate of OAT under prescription is reported and particularly in the oldest old. Among the main causes of this phenomenon an enhanced risk of bleeding is often reported: this due to several factors: risk of falls, the presence of comorbidity and polifarmacy and a reduction in compliance and adherence that are common in the elderly. In recent years the international scenario in the management of OAT has significantly changed since the introduction of the new oral anticoagulants (NOA): Dabigatran, a direct thrombin inhibitor, and two oral factor Xa inhibitors Rivaroxaban and Apixaban, which have all been tested in randomized clinical trial (RELY, ROCKET-AF e ARISTOTLE) which have demonstrated non inferiority compared to warfarin in the prevention of thromboembolic events with an optimal safety profile. NOA could be an important therapeutic opportunity for stroke prevention in elderly patients with AF even if the substantial differences in mean age, anthropometric measures and comorbidity of the patients enrolled in these trials compared with those of the real world setting, oblige some caution and discussion.

scholarly journals Stroke Prevention in Atrial Fibrillation: Understanding the New Oral Anticoagulants Dabigatran, Rivaroxaban, and Apixaban

Thrombosis ◽  
2012 ◽  
Vol 2012 ◽  
pp. 1-10 ◽  
Author(s):  
Tan Ru San ◽  
Mark Yan Yee Chan ◽  
Teo Wee Siong ◽  
Tang Kok Foo ◽  
Ng Kheng Siang ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Stroke Prevention ◽  
Primary Care Physicians ◽  
Vitamin K Antagonists ◽  
Oral Anticoagulants ◽  
New Oral Anticoagulants ◽  
Phase Iii ◽  
Fixed Dose ◽  
Thrombin Inhibitor ◽  
Factor X

Unlike vitamin K antagonists (VKAs), the new oral anticoagulants (NOACs)—direct thrombin inhibitor, dabigatran, and direct activated factor X inhibitors, rivaroxaban, and apixaban—do not require routine INR monitoring. Compared to VKAs, they possess relatively rapid onset of action and short halflives, but vary in relative degrees of renal excretion as well as interaction with p-glycoprotein membrane transporters and liver cytochrome P450 metabolic enzymes. Recent completed phase III trials comparing NOACs with VKAs for stroke prevention in atrial fibrillation (AF)—the RE-LY, ROCKET AF, and ARISTOTLE trials—demonstrated at least noninferior efficacy, largely driven by significant reductions in haemorrhagic stroke. Major and nonmajor clinically relevant bleeding rates were acceptable compared to VKAs. Of note, the NOACs caused significantly less intracranial haemorrhagic events compared to VKAs, the mechanisms of which are not completely clear. With convenient fixed-dose administration, the NOACs facilitate anticoagulant management in AF in the community, which has hitherto been grossly underutilised. Guidelines should evolve towards simplicity in anticipation of greater use of NOACs among primary care physicians. At the same time, the need for caution with their use in patients with severely impaired renal function should be emphasised.

The Efficacy, Safety and Adherence to Treatment when New Anticoagulants Taking in Over 75 Years Old Patients with Atrial Fibrillation

2020 ◽  
Vol 16 (1) ◽  
pp. 10-18
Author(s):  
A. N. Turov ◽  
S. V. Panfilov ◽  
О. V. Tschiglinzeva
Keyword(s):  
Myocardial Infarction ◽  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Oral Anticoagulants ◽  
Daily Intake ◽  
Cardiovascular Death ◽  
New Oral Anticoagulants ◽  
Minor Bleeding ◽  
Observation Study ◽  
Old Patients

Aim. To study the efficacy, safety, and adherence to therapy with new oral anticoagulants in patients older than 75 years with atrial fibrillation.Material and methods. Patients (n=431) over 75 years old (82.7±3.4 years) with various types of atrial fibrillation/flutter (AF) were included in a nonrandomized observational study of new oral anticoagulants (NOAC) in real clinical practice. A history of cardiac surgery was in 27.6% of patients. All patients had >3 risk factors for ischemic stroke (CHA2DS2-VASс 4.81±0.4 points) and >1 risk factor for bleeding (HAS-BLED 3.01±0.2 points). The duration of the observation study was from 12 to 42 (26.9±4.9) months. Dabigatran was taken in 38.5% (n=166) of patients, rivaroxaban – in 41.3% (n=178), apixaban – in 20.2% (n=87) of patients.Results. The incidence of new cases of myocardial infarction was 0.8% per year, surgical revascularization – 0.9% per year, cardiovascular death – 0.8% per year. The frequency of ischemic stroke was 1.1% per year, transient ischemic attacks – 0.4% per year, all thromboembolic episodes – 1.77% per year. The incidence of intracranial hemorrhage was 0.2% per year, of minor bleeding – 4.4% per year, of the combined cardiac point (the total frequency of all strokes, major bleeding, myocardial infarction, mortality from cardiovascular causes, revascularization procedures) – 4.2% per year. Significant differences in the frequency of endpoints depending on the drug of NOAC taken by patients were not found. Violations of the regimen and doses were more often observed with twice daily intake (63.9% for dabigatran and 59.8% for apixaban) than with a single dosage regimen per day (45.5% for rivaroxaban). The leading causes of non-adherence to NOAC therapy in patients over 75 years of age included skipping the next scheduled dose (43.6%) and changing the frequency of the drug taking (16.9%). For NOAC with a double dose per day, dabigatran and apixaban, the frequency of administration was violated in 27.7% and 28.7%, respectively, and with a single dose per day, rivaroxaban – in 1.1%.Conclusion. Therapy with NOAC in patients older than 75 years with AF is effective and safe. There were no statistically significant differences in the incidence of thromboembolic or hemorrhagic events during three NOACs treatment in patients with AF older than 75 years. The incidence of non-adherence was less  

New oral anticoagulants and prevention of thromboembolic events in patients with hypertension and atrial fibrillation

2017 ◽  
Vol 35 (4) ◽  
pp. 689-695 ◽  
Author(s):  
Claudio Borghi ◽  
Stefania Paolillo ◽  
Arrigo F.G. Cicero ◽  
Paola Gargiulo ◽  
Bruno Trimarco ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Oral Anticoagulants ◽  
New Oral Anticoagulants ◽  
Thromboembolic Events ◽  
Prevention Of Thromboembolic Events

Review of efficacy and safety of the new oral anticoagulants (NOACS) in the treatment of venous thromboembolism in gastrointestinal (GI) oncology patients.

2016 ◽  
Vol 34 (4_suppl) ◽  
pp. 761-761
Author(s):  
Hitendra Patel ◽  
Reem Diri ◽  
Ahmed Aljabri ◽  
Christopher Jon Campen ◽  
Emad Elquza ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Average Length ◽  
Oral Anticoagulant Therapy ◽  
Oral Anticoagulants ◽  
Treatment Options ◽  
Previous History ◽  
Secondary Prophylaxis ◽  
New Oral Anticoagulants ◽  
High Rate ◽  
Minor Bleeding

761 Background: The occurrence of venous thrombosis (VTE) has been reported to increase the likelihood of death for cancer patients by 2- to 6-fold. Additionally, cancer patients have both a higher rate of VTE recurrence during oral anticoagulant therapy with warfarin and a higher anticoagulation-associated hemorrhagic risk as compared with non-cancer patients. New oral anticoagulants (NOACs) have administration and monitoring advantages treatment options for patients, however, there is limited data on the use of NOACs for cancer patients. Methods: We performed a single-institution retrospective review of electronic medical records of patients with GI cancer who received rivaroxaban with an active VTE diagnosis. Data collected included patient demographics, diagnosis, previous and active chemotherapy, previous history of VTE, and clinical outcomes. Results: Thirty-two patients were identified, with 28 patients concurrently treated with chemotherapy. Rivaroxaban was given to treat DVT = 23 patient and PE = 9 patients with average length of therapy 181 days. Forty-one percent of patients started on rivaroxaban, while 25% received enoxaparin, and 22% received warfarin prior to rivaroxaban. Overall, 13/32 (41%) patients experienced a bleeding episode; 7 patients had their dose held and 6 patients were noted to have minor bleeding. Conclusions: In our retrospective study, rivaroxaban did show efficacy in secondary prophylaxis for VTE in patients with active cancer. However our results revealed a rather high rate of bleeds in patients being treated with chemotherapy and rivaroxaban as compared to previous studies. [Table: see text]

scholarly journals Anticoagulant therapy in patients with atrial fibrillation and reduced kidney function of diabetic and non-diabetic etiologies

2017 ◽  
Vol 89 (12) ◽  
pp. 10-14
Author(s):  
A A Sokolova ◽  
I S Daabul ◽  
I L Tsarev ◽  
D A Napalkov ◽  
V V Fomin
Keyword(s):  
Atrial Fibrillation ◽  
Kidney Function ◽  
Vitamin K ◽  
Vitamin K Antagonists ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
High Rate ◽  
Thromboembolic Events ◽  
Hemorrhagic Complications

Aim. To evaluate the efficacy and safety of direct oral anticoagulants (DOACs) in patients with atrial fibrillation (AF) and stages I-III chronic kidney disease (CKD). Subjects and methods. The cohort parallel-group study included 92 patients with AF and stages I-III diabetic and non-diabetic CKD, who were treated with DOACs (dabigatran, rivaroxaban, or apixaban) and vitamin K antagonists (warfarin). The follow-up duration was 12 months. Results. Thromboembolic events and bleeding, which required patient hospitalization or blood transfusions, were not recorded during 1-year follow-up. There was no clinically significant progression of CKD in the groups of therapy with vitamin K antagonists or DOACs. Just the same, a more intense decrease in glomerular filtration rate and a high rate of hemorrhagic complications were revealed in the subgroup of patients with diabetes mellitus (DM) versus those with non-diabetic CKD. Conclusion. In patients with non-valvular AF and diabetic and non-diabetic CKD, the use of DOACs effectively and safely prevents thromboembolic events, irrespective of the stage of CKD. At the same time, in patients taking anticoagulants, CKD progresses more rapidly in the presence of DM than in its absence, regardless of a specific anticoagulant. Hemorrhagic complications are more common in patients with AF, DM, and CKD, which requires more frequent monitoring of their kidney function.

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.

New oral anticoagulants in patients with atrial fibrillation

The Lancet ◽  
2014 ◽  
Vol 384 (9937) ◽  
pp. 24
Author(s):  
Wim Opstelten ◽  
Maureen van den Donk ◽  
Ton Kuijpers ◽  
Jako S Burgers
Keyword(s):  
Atrial Fibrillation ◽  
Oral Anticoagulants ◽  
New Oral Anticoagulants

Methods of kidney function assessment in non-valvular atrial fibrillation in the era of new oral anticoagulants

2014 ◽  
Vol 25 (6) ◽  
pp. e71-e72 ◽  
Author(s):  
José Manuel Andreu-Cayuelas ◽  
Francisco Marín ◽  
Pedro José Flores-Blanco ◽  
Arcadio García Alberola ◽  
Sergio Manzano-Fernández
Keyword(s):  
Atrial Fibrillation ◽  
Kidney Function ◽  
Oral Anticoagulants ◽  
New Oral Anticoagulants ◽  
Function Assessment
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