Direct thrombin inhibitors versus vitamin K antagonists for preventing cerebral or systemic embolism in people with non-valvular atrial fibrillation

Salazar, Carlos; Aguila, Daniel del; Cordova, Erika G.

doi:10.1002/14651858.cd009893.pub2

Cited by 45 publications

(31 citation statements)

References 63 publications

(8 reference statements)

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“…We analyzed the association between type of anticoagulation (DOAC versus VKA) with the composite primary endpoint (recurrent ischemic stroke [AIS], intracerebral hemorrhage [ICH], or mortality) using mixed-effects Cox proportional hazards regression models; we calculated adjusted hazard ratios (HRs) with 95% confidence intervals (95% CIs [2][3][4][5][6][7][8][9][10][11][12]); 2,256 (45.9%) patients received VKAs and 2,656 (54.1%) DOACs. Methods: We conducted an individual patient data analysis of seven prospective cohort studies.…”

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confidence: 99%

Direct oral anticoagulants versus vitamin K antagonists after recent ischemic stroke in patients with atrial fibrillation

Seiffge

Paciaroni

Wilson

et al. 2019

Annals of Neurology

118

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Objective We compared outcomes after treatment with direct oral anticoagulants (DOACs) and vitamin K antagonists (VKAs) in patients with atrial fibrillation (AF) and a recent cerebral ischemia. Methods We conducted an individual patient data analysis of seven prospective cohort studies. We included patients with AF and a recent cerebral ischemia (<3 months before starting oral anticoagulation) and a minimum follow‐up of 3 months. We analyzed the association between type of anticoagulation (DOAC versus VKA) with the composite primary endpoint (recurrent ischemic stroke [AIS], intracerebral hemorrhage [ICH], or mortality) using mixed‐effects Cox proportional hazards regression models; we calculated adjusted hazard ratios (HRs) with 95% confidence intervals (95% CIs). Results We included 4,912 patients (median age, 78 years [interquartile range {IQR}, 71–84]; 2,331 [47.5%] women; median National Institute of Health Stroke Severity Scale at onset, 5 [IQR, 2–12]); 2,256 (45.9%) patients received VKAs and 2,656 (54.1%) DOACs. Median time from index event to starting oral anticoagulation was 5 days (IQR, 2–14) for VKAs and 5 days (IQR, 2–11) for DOACs ( p = 0.53). There were 262 acute ischemic strokes (AISs; 4.4%/year), 71 intracranial hemorrrhages (ICHs; 1.2%/year), and 439 deaths (7.4%/year) during the total follow‐up of 5,970 patient‐years. Compared to VKAs, DOAC treatment was associated with reduced risks of the composite endpoint (HR, 0.82; 95% CI, 0.67–1.00; p = 0.05) and ICH (HR, 0.42; 95% CI, 0.24–0.71; p < 0.01); we found no differences for the risk of recurrent AIS (HR, 0.91; 95% CI, 0.70–1.19; p = 0.5) and mortality (HR, 0.83; 95% CI, 0.68–1.03; p = 0.09). Interpretation DOAC treatment commenced early after recent cerebral ischemia related to AF was associated with reduced risk of poor clinical outcomes compared to VKA, mainly attributed to lower risks of ICH. ANN NEUROL 2019;85:823–834.

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confidence: 99%

Direct oral anticoagulants versus vitamin K antagonists after recent ischemic stroke in patients with atrial fibrillation

Seiffge

Paciaroni

Wilson

et al. 2019

Annals of Neurology

118

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“…Large meta-analyses have been conducted of these trials, demonstrating the efficacy of NOACs compared to warfarin. 60,61 The NOACs have been associated with a reduced risk of systemic embolism and stroke compared to warfarin (RR 0.81, 95% CI 0.73-0.91, p < 0.0001), a reduced risk of intracranial hemorrhage (RR 0.48, 95% CI 0.39-0.59, p < 0.0001) and a reduction in all-cause mortality (RR 0.90, 95% CI 0.85-0.95, p = 0.0003). 60 However, these agents have been associated with an increased risk of gastrointestinal bleeding (RR 1.25, 95% CI 1.01-1.55, p = 0.04).…”

Section: Methodsmentioning

confidence: 99%

“…A Cochrane review found that direct thrombin inhibitors were generally comparable to warfarin for many outcomes, although dabigatran 150 mg twice daily was associated with significantly fewer vascular deaths and ischemic events compared to warfarin [Odds ratio (OR) 0.86, 95% CI 0.75-0.99). 61 Direct thrombin inhibitors were also associated with significantly fewer major hemorrhagic events, including hemorrhagic strokes, compared to warfarin. Similarly, a Cochrane meta-analysis of direct factor Xa inhibitors found that these agents were associated with a significant reduction in ischemic and hemorrhagic strokes (OR 0.78, 95% CI 0.69-0.89) and a reduction in major bleeding episodes (OR 0.89, 95% CI 0.81-0.98) compared to warfarin therapy.…”

Section: Methodsmentioning

confidence: 99%

Stroke Prevention in Atrial Fibrillation: Focus on Latin America

Massaro¹,

Lip²

2016

Arquivos Brasileiros De Cardiologia

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Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia, with an estimated prevalence of 1-2% in North America and Europe. The increased prevalence of AF in Latin America is associated with an ageing general population, along with poor control of key risk factors, including hypertension. As a result, stroke prevalence and associated mortality have increased dramatically in the region. Therefore, the need for effective anticoagulation strategies in Latin America is clear. The aim of this review is to provide a contemporary overview of anticoagulants for stroke prevention.The use of vitamin K antagonists (VKAs, eg, warfarin) and aspirin in the prevention of stroke in patients with AF in Latin America remains common, although around one fifth of all AF patients receive no anticoagulation. Warfarin use is complicated by a lack of access to effective monitoring services coupled with an unpredictable pharmacokinetic profile. The overuse of aspirin is associated with significant bleeding risks and reduced efficacy for stroke prevention in this patient group. The non-VKA oral anticoagulants (NOACbs) represent a potential means of overcoming many limitations associated with VKA and aspirin use, including a reduction in the need for monitoring and a reduced risk of hemorrhagic events.The ultimate decision of which anticoagulant drug to utilize in AF patients depends on a multitude of factors. More research is needed to appreciate the impact of these factors in the Latin American population and thereby reduce the burden of AF-associated stroke in this region.

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“…NKGA kaip ir varfarinas efektyviai sumažina tromboembolinių komplikacijų dažnį bei mirties riziką nuo jų [7,8]. Tačiau jie rizikingi dėl galimo kraujavimo operacijos metu, nes šiuo metu tik dabigatranui yra antidotas (idarucizumabas).…”

Section: Tyrimo Objektas Ir Metodikaunclassified

Antikoaguliantų Ir Antiagregantų Vartojimas Akių Chirurgijoje

2017

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Raktažodžiai: antikoaguliantai, antiagregantai, oftalmologinės operacijos. SantraukaAntikoaguliantų ir antiagregantų vartojimo supratimas atliekant akių chirurgines procedūras yra būti-nas, siekiant išvengti sunkių hemoraginių komplikacijų operacijų metu ir pooperaciniu laikotarpiu. Dauguma pacientų, kuriems atliekamos kataraktos, antiglaukominės ar kitos oftalmologinės operacijos, yra vyresnio amžiaus ir reguliariai vartoja įvairių medicinos sričių specialistų paskirtus kraują skystinančius medikamentus. Įprasta prieš tam tikras akių intervencijas nutraukti antitrombozinį gydymą, taip sumažinant kraujavimo riziką, galinčią lemti net negrįžtamą regos praradimą. Krešumą mažinan-čių vaistų vartojimo nutraukimas gali sukelti tromboembolines komplikacijas, ypač pacientams, kuriems atliktos širdies vainikinių kraujagyslių stentavimo, šuntavimo operacijos ar protezuoti širdies vožtuvai. Įvykus sisteminėms komplikacijoms baigtys gali būti blogesnės nei lokalių akių komplikacijų atveju, įskaitant ir blogas gyvenimo prognozes. Atliekamų procedūrų metu stengiamasi išvengti bet kokių komplikacijų, tačiau į gydytojo oftalmologo kompetencijas neįeina kraują skystinančių vaistų skyrimas ar nutraukimas. Profesionaliam specialistų bendradarbiavimui svarbu suprasti kraują skystinančių medikamentų vartojimo reikšmę pacientams, kuriems atliekama tam tikra akių operacija. Darbo tikslas: apžvelgti dažniausiai vartojamus antitrombozinius medikamentus, skirtingų medikamentų vartojimo taktiką bei kraujavimo riziką operaciniu ir pooperaciniu laikotarpiu atliekant skirtingas akių operacijas. Įvadas Tyrimo objektas ir metodikaAtlikta mokslinės literatūros, publikuotos 1993 -2015 m., apžvalga ir sisteminė analizė. Anglų kalba publikuotų mokslinės literatūros šaltinių ieškota duomenų bazėse: PubMed, Cohrane, ScienceDirect, Medline, Medscape, Metapress. Naudoti raktiniai žodžiai: "anticoagulants", "anti-platelet agents", "ophthalmic surgeries", "local complications", "systemic complications". Antitromboziniai medikamentai. Varfarinas yra daž-niausiai vartojamas netiesioginio veikimo antikoaguliantas arba vitamino K antagonistas. Jis inhibuoja nuo vitamino K priklausomų biologiškai aktyvių II, VII, IX ir X krešėji-mo faktorių sintezę [1]. Deja, dėl sudėtingo dozės titravimo vartojant varfariną, sunku balansuoti tarp maksimalios terapinės naudos ir padidėjusios kraujavimo rizikos. Laboratoriniais tyrimais nustatomas protrombino komplekso aktyvumas SPA (angl. serum prothrombin activity), išreiš-kiamas trejopai: procentais, sekundėmis arba santykiu INR (angl. internetional normalized ratio), naudojantis Pasaulio sveikatos organizacijos (PSO) rekomendacijomis. INR nurodo paciento plazmos krešėjimo laiko ir vidutinio normalaus krešėjimo laiko santykį bei atspindi išorinę krešė-jimo kaskadą, kuri periodiškai tiriama vartojant varfariną. Tikslinė INR reikšmė 2,5 (terapinis intervalas nuo 2,0 iki 3,0), siekiant palaikyti normalų kraujo krešumą, vartojant varfariną [2].

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Direct thrombin inhibitors versus vitamin K antagonists for preventing cerebral or systemic embolism in people with non-valvular atrial fibrillation

Abstract: Direct thrombin inhibitors versus vitamin K antagonists for preventing cerebral or systemic embolism in people with non-valvular atrial fibrillation.

Cited by 45 publications

References 63 publications

Direct oral anticoagulants versus vitamin K antagonists after recent ischemic stroke in patients with atrial fibrillation

Direct oral anticoagulants versus vitamin K antagonists after recent ischemic stroke in patients with atrial fibrillation

Stroke Prevention in Atrial Fibrillation: Focus on Latin America

Antikoaguliantų Ir Antiagregantų Vartojimas Akių Chirurgijoje

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