Direct oral anticoagulants for stroke prevention in atrial fibrillation: treatment outcomes and dosing in special populations

Abstract

Overall, results of secondary analyses indicate that the recommended dosing strategy for each of the DOACs produces a consistent anticoagulant effect across a diverse patient population, including those at increased risk of stroke or bleeding.

Study protocol for aspirin plus rivaroxaban efficacy and safety in embolic stroke of undetermined source: A randomized, placebo controlled, outcome assessor blind, feasibility study

“…To date, limited studies have been performed on the use of direct oral anticoagulants (DOACs) regarding their efficacy and safety profile. 9 According to DOACs effects on prevention of embolic stroke in AF patients 13 , anticoagulants have been hypothesized to be more efficient than antiplatelet drugs for secondary prevention following ESUS. So various randomized trials designed at reducing recurrent stroke in ESUS with DOACs.…”

The edoxaban‐M4 metabolite and measurement of edoxaban by chromogenic assays in human plasma

“…Furthermore, they are now widely used in various thromboembolic diseases. Although there is no need of routine monitoring thanks to the predictable pharmacokinetic and pharmacodynamic profiles of DOACs, some clinical situations require to monitor patients while they are on‐treatment (e.g., to assess the degree of anticoagulation before an urgent or elective surgery; before thrombolysis; in case of bleeding episodes or recurrence of thrombotic events; in case of overdosage or suspected progressive accumulation) 2,3,20,21 . Edoxaban, which has been available since 2016 under the brand name of Lixiana, received its market authorization for the thromboembolic prevention in patients with nonvalvular atrial fibrillation as well as for the treatment and secondary prevention of deep venous thrombosis and pulmonary embolism 3,22,23 .…”

“…Although there is no need of routine monitoring thanks to the predictable pharmacokinetic and pharmacodynamic profiles of DOACs, some clinical situations require to monitor patients while they are on-treatment (e.g., to assess the degree of anticoagulation before an urgent or elective surgery; before thrombolysis; in case of bleeding episodes or recurrence of thrombotic events; in case of overdosage or suspected progressive accumulation). 2,3,20,21 Edoxaban, which has been available since 2016 under the brand name of Lixiana, received its market authorization for the thromboembolic prevention in patients with nonvalvular atrial fibrillation as well as for the treatment and secondary prevention of deep venous thrombosis and pulmonary embolism. 3,22,23 As previously reported, among FXa inhibitors, edoxaban is the only compound to release pharmacologically active metabolites (e.g., predominantly edoxaban-M4 [M4] representing ±10% of total edoxaban and incidentally edoxaban-M6 [M6], and edoxaban-M8 [M8], representing less than 10% overall), which could interfere, especially in case of drug-drug interactions or physiological disorders (i.e., hepatic or renal impairment), with chromogenic anti-Xa based assays.…”

“…2,3,20,21 Edoxaban, which has been available since 2016 under the brand name of Lixiana, received its market authorization for the thromboembolic prevention in patients with nonvalvular atrial fibrillation as well as for the treatment and secondary prevention of deep venous thrombosis and pulmonary embolism. 3,22,23 As previously reported, among FXa inhibitors, edoxaban is the only compound to release pharmacologically active metabolites (e.g., predominantly edoxaban-M4 [M4] representing ±10% of total edoxaban and incidentally edoxaban-M6 [M6], and edoxaban-M8 [M8], representing less than 10% overall), which could interfere, especially in case of drug-drug interactions or physiological disorders (i.e., hepatic or renal impairment), with chromogenic anti-Xa based assays. 19,24 Currently, these assays are considered the most appropriate to estimate concentration of FXa inhibitors in clinical practice.…”

“…Direct oral anticoagulants (DOACs) include the direct thrombin inhibitor (dabigatran etexilate) and the direct factor Xa (FXa) inhibitors (apixaban, betrixaban, edoxaban, and rivaroxaban). [1][2][3][4] According to the European Society of Cardiology, the American College of Chest Physicians, and the Canadian Cardiovascular Society guidelines, [5][6][7][8] DOACs are preferred over vitamin K antagonists (VKAs) for certain conditions such as nonvalvular atrial fibrillation and venous thromboembolism according to several studies highlighting their favorable benefit-to-risk profile. [9][10][11][12][13][14] However, VKAs are still favorable in patients with mechanical heart valves or for the treatment of triple-positive antiphospholipid syndrome.…”