2018 KHRS Practical Guide on the Use of Non-Vitamin K Antagonist Oral Anticoagulants in Korean Patients with Atrial Fibrillation: How to Initiate and Organize the Follow-up

박진규,; 김준,; 백용수,; 이소령,; 황유미,; 김태훈,; 이대인,; 이기홍,; 심재민,; 정보영,

doi:10.3904/kjm.2019.94.1.17

Cited by 3 publications

(5 citation statements)

References 169 publications

(2 reference statements)

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“…Firstly, we evaluated total of 283 ESKD patients who recently initiated DOAC therapy and compared the outcomes with those on warfarin. Despite the 2018 Korean Heart Rhythm Society (KHRS) Practical Guidelines not recommending DOAC use in hemodialysis (HD) patients [16], this study provides real-world evidence regarding DOAC use in ESKD patients. Anti-coagulation in ESKD patients is very difficult.…”

Section: Discussionmentioning

confidence: 99%

“…KHRS recommends tailoring DOACs selection according to clinical situations in the general population. For instance, in cases of recurrent ischemic stroke despite appropriate anticoagulant therapy, dabigatran administration is suggested, while in high-risk groups for GI bleeding, apixaban or dabigatran administration is preferred [16]. However, many HD patients are prescribed DOAC in real world.…”

Section: Discussionmentioning

confidence: 99%

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Real World Outcomes of Direct Oral Anticoagulant in End Stage Kidney Disease on Dialysis

Lee,

Choi,

Kim

et al. 2024

JKDA

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Background: Patients with end stage kidney disease (ESKD) are at an increased risk of both thromboembolic events and bleeding. Direct oral anticoagulant (DOAC) agents has been developed as alternatives to warfarin. These medications have advantages such as a predictable anticoagulant effect, fewer drug interactions, and no need for routine monitoring of blood levels. However, their use in patients with ESKD requires consideration. Material and Methods: This study was a retrospective, observational cohort study who was treated with DOAC and warfarin for anticoagulation. Based on the common data model database, DOAC exposure included apixaban, edoxaban, rivaroxaban, and dabigatran. Outcomes included occurrence of malignancy, gastrointestinal (GI) bleeding, brain hemorrhage, and major adverse cardiovascular event.. Results: Total 680 patients with ESKD on dialysis were enrolled. Apixaban (88.7%) was most frequently used and followed with edoxaban, rivaroxaban, and dabigatran. Drug pathway was different among hospitals. DOAC group was older compared with warfarin group. Outcomes in DOAC group were less compared with those in warfarin group except brain hemorrhage. After propensity score (PS) matching, the estimation of outcomes was not different with DOAC and warfarin. Conclusion: Outcomes of DOAC in patients with ESKD on dialysis are not inferior with those of warfarin.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Real World Outcomes of Direct Oral Anticoagulant in End Stage Kidney Disease on Dialysis

Lee,

Choi,

Kim

et al. 2024

JKDA

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“…Increased use of apixaban and decreased use of dabigatran in the presence of renal disease are consistent with reports on renal elimination rates. The renal elimination rates for each NOAC are as follows: 80% for dabigatran, 50% for edoxaban, 33% for rivaroxaban, and 27% for apixaban, 43,47 and according to recent guidelines, apixaban can be used with relatively no dose adjustment for a wide range of renal functions. 29…”

Section: Discussionmentioning

confidence: 99%

Factors Influencing the Selection of Non-Vitamin K Antagonist Oral Anticoagulants for Stroke Prevention in Patients With Non-Valvular Atrial Fibrillation

Park

2021

J Cardiovasc Pharmacol Ther

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Background: Major atrial fibrillation (AF) guidelines recommend non-vitamin K antagonist oral anticoagulants (NOACs) over warfarin, except in rare clinical circumstances based on 4 randomized controlled trials comparing each NOAC with warfarin. We aimed to investigate the current NOAC prescription behaviors in alignment with the recent clinical evidence available. Method: We conducted a cross-sectional analysis of NOAC-using patients with non-valvular atrial fibrillation (NVAF) who were aged ≥65 years on the index date (July 1, 2018) based on nationwide claims data. The types of NOACs being taken were analyzed using chi-squared tests, and factors influencing NOAC selection were identified using multinomial logistic regression analysis. Results: A total of 6,061 patients were included. Among the 4 NOACs, rivaroxaban was the most used NOAC. Patients aged ≥75 years (odds ratio [OR] = 1.270, confidence interval [CI] = 1.089-1.450) and women (OR = 1.148, CI = 1.011-1.284) were more likely to use apixaban relative to rivaroxaban. Patients with prior stroke/transient ischemic attack/thromboembolism had higher odds of using dabigatran (OR = 1.508, CI = 1.312-1.704) and apixaban (OR = 1.186, CI = 1.026-1.346). Patients with renal disease had higher odds of using apixaban (OR = 1.466, 95% CI = 1.238-1.693). These findings are consistent with the efficacy and safety profiles reported in pivotal trials and observational studies comparing individual NOACs. Conclusion: Among the 4 NOACs, rivaroxaban was the most commonly used NOAC. Apixaban was preferred for patients aged ≥75 years, females, and patients with renal disease.

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“…Non-vitamin K antagonist oral anticoagulants (NOACs), such as dabigatran, rivaroxaban, apixaban, and edoxaban, have been approved for use in Korea. 3 NOACs with direct thrombin inhibition (dabigatran) and direct active factor Xa inhibition (rivaroxaban, apixaban, and edoxaban) pathways have a large therapeutic potential, a fixed dosing regimen, and few interactions with food or drugs. In addition, regular monitoring of international normalized ratio (INR) levels is not essential.…”

Section: Introductionmentioning

confidence: 99%

“…Variables, Levels of Variables, and Composition of the R-C-P Complex in Each Experiment Designed Using 23 Full Factorial Design…”

mentioning

confidence: 99%

Design and Optimization of Rivaroxaban-Cyclodextrin-Polymer Triple Complex Formulation with Improved Solubility

Kang¹,

Lee²,

Jeong³

et al. 2022

DDDT

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Purpose This study aimed to ensure the convenience of administration and reproducibility of efficacy, regardless of the meal, by improving the solubility of rivaroxaban (RIV). Methods RIV is a non-vitamin K antagonist oral anticoagulants that exhibits a coagulation effect by directly inhibiting coagulation factor Xa. However, RIV has a very low solubility; therefore, it must be administered with a meal at high doses. We used a drug- hydroxypropyl-beta-cyclodextrin (CD)-water-soluble polymer triple complex (R-C-P complex) to solubilize RIV. Using Minitab, we evaluated the effect of each factor on RIV solubility and developed an optimal R-C-P complex formulation. The amount of CD, amount of polymer, and polymer type were set as the independent variables X 1 , X 2 , and X 3 , respectively. RIV solubility (Y 1 ) and dissolution rate for 45 min in pH 4.5 medium (Y 2 ) and pH 1.2 medium (Y 3 ) were set as response variables. Results The most efficient RIV solubilization effect was obtained from the composition using CD and HPMC 2208, and physicochemical properties and dissolution parameters were analyzed. RIV in the R-C-P complex was present in an amorphous form and showed high solubility. Unlike commercial products, it showed a 100% dissolution rate. The R-C-P complex formulation secured high RIV solubility and 100% release regardless of pH. Conclusion The results imply that high-dose RIV can be administered regardless of the meal, reducing the risk of changing the drug effect due to the patient’s administration mistake.

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2018 KHRS Practical Guide on the Use of Non-Vitamin K Antagonist Oral Anticoagulants in Korean Patients with Atrial Fibrillation: How to Initiate and Organize the Follow-up

Cited by 3 publications

References 169 publications

Real World Outcomes of Direct Oral Anticoagulant in End Stage Kidney Disease on Dialysis

Real World Outcomes of Direct Oral Anticoagulant in End Stage Kidney Disease on Dialysis

Factors Influencing the Selection of Non-Vitamin K Antagonist Oral Anticoagulants for Stroke Prevention in Patients With Non-Valvular Atrial Fibrillation

Design and Optimization of Rivaroxaban-Cyclodextrin-Polymer Triple Complex Formulation with Improved Solubility

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