Direct Oral Anticoagulants: An Updated Systematic Review of Their Clinical Pharmacology and Clinical Effectiveness and Safety in Patients With Nonvalvular Atrial Fibrillation

Bortman, Lucia Victoria; Mitchell, Florencia; Naveiro, Sofia; Morales, Juana Pérez; González, Claudio; Girolamo, Guillermo Di; Giorgi, Mariano

doi:10.1002/jcph.2184

Cited by 10 publications

(3 citation statements)

References 73 publications

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“…AF is a chronic progressive disorder [35] . Age and underlying comorbidities are associated with the natural progression rate of PAF to persistent AF, which can reach up to 24.7% over the course of 5 years [36] .…”

Section: Discussionmentioning

confidence: 99%

Catheter ablation of atrial fibrillation in the young: a systematic review and meta-analysis

Zhan

Zheng

Huang

et al. 2023

Preprint

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Aims The differences in the clinical outcomes of rhythm and safety after catheter ablation in young and old atrial fibrillation(AF) patients remain unclear. The purpose of this study was to compare the clinical outcomes of catheter ablation for in young and old AF patients. Methods and results The Medline and EMBASE databases were searched for published articles up to Octomber 2022. Studies that met our predefined inclusion criteria were included. The primary endpoints were freedom from AF/atrial tachycardia (AT) recurrence, safety ouctcomes including the stroke/transient ischaemic attack (TIA), cardiac tamponade and pericardial effusion. After literature search and detailed assessment, 6 studies (9982 patients) were identified. Our analyses showed that the rate of freedom from AF/AT recurrence was higher in young than old AF patients after ablation [odds ratio (OR): 0.58, 95% confidence interval (CI) 0.36–0.92; P -0.02]. Compared to older patients, there were similar rate of adverse outcomes including pericardial effusion /tamponade (OR=0.61, 95%CI 0.29-1.27,P=0.18), hematoma(OR=1.87, 95%CI 0.62,5.63, P=0.27) and stroke/ TIA rate(OR=0.25, 95%CI 0.05,1.41, P=0.12) . Conclusions In younger atrial fibrillation patients, there is a lower major complication rate and a comparable efficacy rate, with a greater chance of being AF free without antiarrhythmic drugs. These findings suggest that it may be appropriate to consider ablative therapy as first-line therapy in this age group.

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Section: Discussionmentioning

confidence: 99%

Catheter ablation of atrial fibrillation in the young: a systematic review and meta-analysis

Zhan

Zheng

Huang

et al. 2023

Preprint

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“…This activity can be expected as early as within the first 4 hours of administration and may last up to 48 hours or more in some patients (e.g. patients with impaired renal function) [3,4]. Importantly, the in-hospital mortality rate is nearly 30% in patients with spontaneous intracranial haemorrhage receiving factor Xa inhibitors, with a higher risk of mortality in patients on factor Xa inhibitors than in those without anticoagulation [5].…”

Section: Introductionmentioning

confidence: 99%

Recommendations for the use of andexanet alfa in the management of bleeding in patients on oral factor Xa inhibitors in Switzerland

Angelillo‐Scherrer¹,

Casini²,

Studt³

et al. 2023

Swiss Med Wkly

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Anticoagulants are essential in preventing and treating thrombosis. Unfortunately, their use is accompanied by an enhanced risk of bleeding. Since the introduction of direct oral anticoagulants (DOACs), the risk of major bleeding has been reduced but not eliminated. Major bleeding events related to the use of factor Xa inhibitors can be challenging to manage. In recent years, four-factor prothrombin complex concentrates have been used in patients with severe bleeding taking oral direct factor Xa inhibitors (apixaban, edoxaban and rivaroxaban). Andexanet alfa (OndexxyaTM, AstraZeneca AG) is a specially designed recombinant version of human factor Xa that acts as a decoy receptor to reverse the effects of factor Xa inhibitors. Since 2 December 2020, andexanet alfa has been used in Switzerland for adult patients receiving apixaban or rivaroxaban when reversal of anticoagulation is required because of life-threatening or uncontrolled bleeding. However, the use of andexanet alfa remains a challenge owing to its cost, the reported thrombotic complications and the fact that its efficacy mainly relates to intracranial haemorrhage. Moreover, the use of nonspecific reversal agents together with andexanet alfa is controversial. The present recommendations on the use of andexanet alfa in the management of bleeding in patients on factor Xa inhibitors in Switzerland were developed by a group of Swiss experts from the Working Party Hemostasis of the Swiss Society of Hematology. These recommendations aim to provide support to clinicians in their decision-making in the management of patients with major bleeding receiving factor Xa inhibitors.

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“…It has been suggested to lead to several adverse events, such as stroke. 4) Current treatments, such as antiarrhythmic drugs, including beta-blockers and amiodarone, have successfully reduced PoAF to some extent, 5) but are far from being universally effective. Thus, deciphering the mechanism of PoAF potentiates the universal amelioration of PoAF.…”

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confidence: 99%

Associations of ApoE Polymorphisms with Postoperative Atrial Fibrillation and Cardiac Injury in Patients with Coronary Artery Bypass Graft Surgery

Xue,

Fan,

Liu

2023

Int. Heart J.

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Genetic factors may be involved in postoperative atrial fibrillation (PoAF) development and cardiac injury. However, the associations of the apolipoprotein E (ApoE) gene polymorphisms with PoAF and cardiac injury after coronary artery bypass graft surgery (CABG) remain unclear.We recruited 150 patients with CABG, comprising 92 and 58 cases for the ApoE4 and ApoE3 groups, respectively, and analyzed PoAF incidence and the levels of cardiac biomarkers, including N-terminal prohormone of brain natriuretic peptide, cardiac troponin T (cTnT), and cardiac troponin I (cTnI). The linear regression model or logistic regression analysis was applied to investigate the associations of ApoE gene polymorphisms with PoAF and biomarkers for cardiac injury.A total of 58 (38.7%) patients with CABG developed PoAF, with 40 and 18 cases in the ApoE4 and ApoE 3 groups (43.5% versus 31.0%, P < 0.05), respectively. Logistic regression analysis revealed that the ApoE4 allele was an independent risk factor for PoAF (OR = 3.340, P = 0.001), while the ApoE3 allele was a protective factor for the PoAF (OR = 0.841, P = 0.043). Patients carrying the ApoE4 allele had higher levels of cTnT and cTnI than those carrying the ApoE3 allele. ApoE3 was a protective factor for cardiac injury (β = −0.220, P = 0.001), whereas ApoE4 was a risk factor for cTnI (β = 0.335, P = 0.015).Our study reveals that the ApoE allele contributes to the occurrence of PoAF and severity of cardiac injury in an allele-dependent manner, with the ApoE4 allele increasing the risk and the ApoE3 allele reducing the risk.

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Direct Oral Anticoagulants: An Updated Systematic Review of Their Clinical Pharmacology and Clinical Effectiveness and Safety in Patients With Nonvalvular Atrial Fibrillation

Cited by 10 publications

References 73 publications

Catheter ablation of atrial fibrillation in the young: a systematic review and meta-analysis

Catheter ablation of atrial fibrillation in the young: a systematic review and meta-analysis

Recommendations for the use of andexanet alfa in the management of bleeding in patients on oral factor Xa inhibitors in Switzerland

Associations of ApoE Polymorphisms with Postoperative Atrial Fibrillation and Cardiac Injury in Patients with Coronary Artery Bypass Graft Surgery

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