Comparison of Anticoagulant Therapy for Atrial Fibrillation - Novel Oral Anticoagulants Versus Vitamin K Antagonists

Chen, Sean T.; Patel, Manesh R.

doi:10.1016/j.pcad.2018.01.005

Cited by 15 publications

(23 citation statements)

References 93 publications

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“…The retinal pigment epithelial cells also express various coagulation factors including tissue factor and factor VII 17 , which may www.nature.com/scientificreports www.nature.com/scientificreports/ explain the safety of NOACs in terms of intraocular bleeding. NOACs directly inhibit specific coagulation factors (dabigatran: factor II; rivaroxaban, apixaban, and edoxaban: factor X), so that NOACs may preserve hemostatic mechanisms by selectively targeting thrombin and not interfering tissue factor-VIIa complexes 4,16 . Warfarin has limitations related with the diet and drug interaction and the need for anticoagulation monitoring, and the pharmacokinetics of warfarin is less predictable due to the polymorphisms in the genes (CYP2C9, VKORC1, etc.)…”

Section: Discussionmentioning

confidence: 99%

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Efficacy and safety of non-vitamin K-antagonist oral anticoagulants for retinal vascular diseases in patients with atrial fibrillation: Korean cohort study

Park

Lee

et al. 2020

Sci Rep

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We investigated the prevalence of retinal vascular occlusion and intraocular bleeding and compare their risks in patients undergoing anticoagulant therapy, either with non-vitamin K-antagonist oral anticoagulants (NOAC) or warfarin. We performed a cohort study (January 2015 to April 2018) in 281,970 patients with nonvalvular atrial fibrillation (AF) using health claims in the nationwide database of the Health Insurance Review and Assessment service of Korea. A Cox-proportional hazard regression was used to calculate the hazard ratio (HR) for retinal vascular occlusion or intraocular bleeding. The HR of retinal vascular occlusion was estimated to 1.59 (95% confidence interval [CI], 1.35-1.86) for NOAC users compared to that with warfarin users. Among the various types of NOACs, all NOACs showed higher risk of retinal vascular occlusion than did warfarin. For intraocular bleeding, the HR was estimated to be 0.86 (95% CI, 0.75-0.98) for NOAC users compared with that with warfarin users. The risk of retinal vascular occlusion was higher in NOAC users than in warfarin users, while the risk of intraocular bleeding was lower with NOAC therapy. NOACs were not found to be as effective as warfarin for retinal vascular occlusion, but safe in terms of intraocular bleeding.

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Section: Discussionmentioning

confidence: 99%

“…Non-vitamin K-antagonist oral anticoagulants (NOACs) have been recently approved for prevention of stroke in patients with non-valvular AF, and do not require anticoagulation monitoring 3 . Since NOACs are at least as effective and safe compared to warfarin, they have become essential for patients with non-valvular AF 4 .…”

mentioning

confidence: 99%

Efficacy and safety of non-vitamin K-antagonist oral anticoagulants for retinal vascular diseases in patients with atrial fibrillation: Korean cohort study

Park

Lee

et al. 2020

Sci Rep

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“…OAKT je preporučena Vodičima za pacijente sa umernim i visokim rizikom za moždani udar koji nemaju kontraindikacije (TABELA 2). Takođe, korišćenje direktnih, pravilnije ne-vitamin K oralnih antikoagulansa (NOAK, NOAC) sve više se uvećava, ali bez velikih studija praćenja dugotrajnog lečenja [10,11].…”

Section: Uvodunclassified

“…U stvarnom životu, van studija, retko se postižu ovi standardi što povećava mogućnost tromboembolijskih komplikacija i velikih krvarenja. Postoje jaki dokazi da je apsolutni benefit od OAKT veći što je veći tromboemboliski rizik prema CHA2DS2-VASc skoru, pa u celom kontekstu NOAK lekovi imaju veći klinički benefit u poređenju sa VKA posebno u najrizičnijih pacijenata [10,11,27].…”

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“…Bilo bi poželjno da velike propsektivne studije urade sveobuhvatno praćenje ovih fakora. Lekari treba da ohrabre pacijente da intenziviraju marljivost u redovnom uzimanju leka i kontroli INR kada koriste antagoniste vitamina K (VKA) i da razmotre prelazak na nove antikoagulantne, Ne-Vitamin-K antagoniste u prvom redu dabigatran i rivaroksaban kao terapijske opcije u bolesnika sa AF gde je labilan INR ili loša komlijansa u kontroli INR [10,11,26,27].…”

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A yearlong monitoring of the quality of oral anticoagulation therapy in patients with atrial fibrillation and analysis of its influence on the quality of anticoagulation

Aranđelović¹,

Raščanin²,

Bastać³

et al. 2017

Timočki medicinski glasnik

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INTERNISTIČKA ORDINACIJA "DR BASTAĆ", KOSAN Sažetak:CILJ ISPITIVANJA: odrediti broj bolesnika koji imaju optimalan nivo antikoagulantnog efekta jednogodišnjim praćenjem vrednosti PT/INR u posmatranoj grupi ispitanika i koji faktori, komorbiditeti i ehokardiografski param (OAKT). MATERIJAL I METODE: Ovom longitudinalnom, prospektivnom studijom je obuhvaćeno konsektivnih 87 bolesnika sa atrijalnom fibrilacijom bolesnika a na varfarinu 19/87 (22%). Odlična antikoagulisanost je da u toku godinu dana 5 do 7 izmerenih vrednosti PT/INR bude (analogno vremenu u terapijskom opsegu da 3 do 4 vrednosti PT /INR budu u terapijskom opsegu (analogno TTR 50 do 60% vremena) dok je slaba antikoagulisanost: 0-2 izmerene vrednosti INR u terapijskom opsegu (TTR <50 toku praćenja od godinu dana, na osno atrijalnom fibrilacijom je klasifikovano u tri grupe: grupa A efekta N=14/87 (16%); grupa B -do antikoagulacije N=49/87 (56%). Srednja vrednost nešto viša u grupi C (A=3,3, vs B=3,4 Vs C=3,6) dok je rizik od krvavljenja značajno niži u grupi C (A-28,6 vs B-32 vs gojazni bolesnici (A-57%, B-56%, C-48%) i predg (Xi²= 0.487). Najviši nivo glikemije je bio u grupi C (C značajno više dijabetičara (C=31% versus A nađena je statistički značajno viši indeks mase miokarda (LVMI) u grupi C vs C, p=0,039) i B=117 g/m 2 B vs C, terapije dikumaroloskim preparatima u cilju prevencije tromboembolizma je u toku jednogodišnjeg praćenja bio samo u 16% bolesnika, a dobar čak 56% bolesnika. Od kliničkih faktora koji su povezani sa slabim antikoagulantnim efektom značajni su prisustvo hiperglikemije i dijabeta. Ehokardiografski odre statistički značajno povezana sa slabim antikoagulantnim efektom. Ipak glavni razlog loše antikoagulisanosti. Ključne reči: atrijalna fibrilacija, oralna antikogulantna terapija, tromboembolizam, hipertroifija leve komore, dijabetes melitus, gojaznost. Vol. 42Internistička ordinacija "Dr Bastać", Kosančićev venac br.16, ZAJEČAR INTERNISTIČKA ORDINACIJA "DR BASTAĆ", KOSANČIĆEV VENAC BR 16, ZAJEČAR CILJ ISPITIVANJA: odrediti broj bolesnika koji imaju optimalan nivo antikoagulantnog efekta jednogodišnjim praćenjem vrednosti PT/INR u posmatranoj grupi ispitanika i koji faktori, komorbiditeti i ehokardiografski parametri su udruženi sa efikasnošću oralne antikoagulantne terapije ). MATERIJAL I METODE: Ovom longitudinalnom, prospektivnom studijom je obuhvaćeno konsektivnih 87 bolesnika sa atrijalnom fibrilacijom na OAKT. Na acenokumarolu je bilo 68/87 (78%) bolesnika a na varfarinu 19/87 (22%). Razvijeni su orginalni kriterijumi za kvalitet antikoagulisnoasti.antikoagulisanost je da u toku godinu dana 5 do 7 izmerenih vrednosti PT/INR bude rapijskom opsegu -TTR >60-85% vremena). Dobra antikoagulisanost je definisana da 3 do 4 vrednosti PT /INR budu u terapijskom opsegu (analogno TTR 50 do 60% vremena) dok je slaba 2 izmerene vrednosti INR u terapijskom opsegu (TTR <50%). REZULTATI RADA: U toku praćenja od godinu dana, na osnovu sukcesivnih vrednosti PT/INR, ukupno 87 bolesnika sa atrijalnom fibrilacijom je klasifikovano u tri grupe: ...

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Novel oral anticoagulants versus vitamin K antagonists in patients with atrial fibrillation after transcatheter aortic valve replacement: A systematic review and meta‐analysis

Memon

Siddiqui

Amin

et al. 2022

Cathet Cardio Intervent

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Background The efficacy and safety of novel oral anticoagulants (NOACs) compared to the current guideline‐recommended vitamin K antagonists (VKAs) in atrial fibrillation (AF) patients undergoing transcatheter aortic valve replacement (TAVR) has not been well established. We pooled evidence from all available studies to assess the risks and benefits of this drug class. Methods We queried electronic databases (MEDLINE, Scopus, and Cochrane central) up until January 28th, 2022 for studies comparing NOACs to VKAs in AF patients undergoing TAVR. Results from studies were presented as risk ratios (RR) and pooled using a random‐effects model. Subgroup analysis by study design and meta‐regression analysis were performed to explore heterogeneity. Results A total of 12 studies (3 RCTs and 9 observational) containing 12,203 patients (mean age 81.2 years; 50.5% men) were identified and included in the analysis. Pooled analysis revealed no significant difference between NOACs and VKAs in terms of stroke or systemic embolism (RR: 0.78; p = 0.18), major bleeding (RR: 0.84; p = 0.32), intracranial hemorrhage (RR 0.61; p = 0.06), all‐cause mortality (RR: 0.69; p = 0.07), and myocardial infarction (RR: 1.60; p = 0.24) at a mean length of follow‐up of 15.1 months. RCTs and observational studies did not significantly differ across outcomes on subgroup analysis. Meta‐regression analysis found heterogeneity in all‐cause mortality to be significantly explained by percentage of males (coefficient: 0.049, p = 0.007), mean age (coefficient: 0.221, p < 0.001), and CHA2DS2‐VASc score (coefficient: −1.657, p < 0.001). Conclusions This meta‐analysis suggests that outcomes with NOACs do not significantly differ compared to VKAs following TAVR in patients with AF.

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Comparison of Anticoagulant Therapy for Atrial Fibrillation - Novel Oral Anticoagulants Versus Vitamin K Antagonists

Cited by 15 publications

References 93 publications

Efficacy and safety of non-vitamin K-antagonist oral anticoagulants for retinal vascular diseases in patients with atrial fibrillation: Korean cohort study

Efficacy and safety of non-vitamin K-antagonist oral anticoagulants for retinal vascular diseases in patients with atrial fibrillation: Korean cohort study

A yearlong monitoring of the quality of oral anticoagulation therapy in patients with atrial fibrillation and analysis of its influence on the quality of anticoagulation

Novel oral anticoagulants versus vitamin K antagonists in patients with atrial fibrillation after transcatheter aortic valve replacement: A systematic review and meta‐analysis

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