Edoxaban in elderly patient with morbid obesity and atrial fibrillation: the role of plasma levels evaluation for selecting the appropriate dose

Russo, Vincenzo; Rago, Anna; Laezza, Nunzia; Micco, Pierpaolo Di; Giannetti, L.M.; Atripaldi, Luigi; D’Onofrio, Antonio; Golino, Paolo; Nigro, Gerardo

doi:10.4081/monaldi.2020.1224

Cited by 9 publications

(3 citation statements)

References 17 publications

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“…The reasons for the known greater thromboembolic risk in women than in men remain unclear but may include older age, under-treatment with anticoagulant therapy, and poor anticoagulation control [ 93 ]. Many studies [ 94 , 95 , 96 , 97 , 98 , 99 , 100 , 101 ] were very well designed to assess the effectiveness of NOACs versus VKAs for thromboembolic risk prevention in NVAF, but sex-associated risk during NOACs treatment is not still understood. Law et al [ 102 ] compared the effectiveness and safety outcomes of NOACs versus VKAs in 4972 men and 4834 women, showing that NOACs use was associated with a lower risk of intracranial hemorrhages (ICH) (HR: 0.16, 95% CI [0.06, 0.40]) and all-cause mortality (HR: 0.55, 95% CI [0.39, 0.77]) in women but not in men without significant differences in terms of stroke and TE incidence.…”

Section: Resultsmentioning

confidence: 99%

Gender Differences in Atrial Fibrillation: From the Thromboembolic Risk to the Anticoagulant Treatment Response

et al. 2023

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Atrial fibrillation (AF) is the most common cardiac arrhythmia associated with an increased thromboembolic risk. The impact of the female sex as an independent risk factor for thromboembolic events in AF is still debated. Background and Objectives: The aim of this review is to evaluate the gender-related differences in cardioembolic risk and response to anticoagulants among AF patients. Materials and Methods: The PubMed database is used to review the reports about gender differences and thromboembolic risk in atrial fibrillation. Results: Non-vitamin K oral anticoagulants (NOACs) represent the gold standard for thromboembolic risk prevention in patients with non-valvular atrial fibrillation (NVAF). Despite a similar rate of stroke and systemic embolism (SE) among men and women in NOACs or vitamin K antagonists (VKAs) treatment, the use of NOACs in AF women is associated with a lower risk of intracranial bleeding, major bleeding, and all-cause mortality than in men. Conclusions: The female sex can be defined as a stroke risk modifier rather than a stroke risk factor since it mainly increases the thromboembolic risk in the presence of other risk factors. Further studies about the efficacy and safety profile of NOACs according to sex are needed to support clinicians in performing the most appropriate and tailored anticoagulant therapy, either in male or female AF patients.

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Section: Resultsmentioning

confidence: 99%

Gender Differences in Atrial Fibrillation: From the Thromboembolic Risk to the Anticoagulant Treatment Response

et al. 2023

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“…Therefore, assessment of the anticoagulant effect of DOACs may be desirable in certain rare situations, such as extreme body weight, concomitant oncologic therapies, patients after transplantation, patients on HIV medication, etc. [ 201 , 202 ].…”

Section: Discussionmentioning

confidence: 99%

Antioxidant Properties of Oral Antithrombotic Therapies in Atherosclerotic Disease and Atrial Fibrillation

et al. 2023

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The thrombosis-related diseases are one of the leading causes of illness and death in the general population, and despite significant improvements in long-term survival due to remarkable advances in pharmacologic therapy, they continue to pose a tremendous burden on healthcare systems. The oxidative stress plays a role of pivotal importance in thrombosis pathophysiology. The anticoagulant and antiplatelet drugs commonly used in the management of thrombosis-related diseases show several pleiotropic effects, beyond the antithrombotic effects. The present review aims to describe the current evidence about the antioxidant effects of the oral antithrombotic therapies in patients with atherosclerotic disease and atrial fibrillation.

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“…51 Notwithstanding, real life studies have not found reduced efficacy or safety of DOACs in this population. [52][53][54][55][56] It is suggested to use VKAs instead of DOACs in extremely obese patients. If DOACs are used, monitoring of drug trough levels should be considered, switching to a VKA if drug levels fall below the expected "on therapy" range.…”

Section: Patients At the Extremes Of Body Weightmentioning

confidence: 99%

Direct Oral Anticoagulants Plasma Levels Measurement: Clinical Usefulness from Trials and Real-World Data

Renon

Rago

Liccardo

et al. 2021

Semin Thromb Hemost

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Measurement of direct oral anticoagulants (DOACs) activity is not routinely necessary. Indeed, evaluation of DOACs plasmatic concentration is discouraged for the majority of patients, due to the lack of outcome data supporting this approach. Nevertheless, DOAC measurements may be useful in emergency situations such as serious bleeding events, need for urgent invasive procedures, and acute ischemic stroke or in managing anticoagulation in “special populations” not adequately studied in clinical trials, for example the very elderly or those at the extremes of body weight. The aim of this review is to describe and summarize the methods for DOACs activity evaluation and the settings in which their plasma level measurement may be indicated, analyzing indications from scientific societies and evidence from clinical trials, as well as real world data on the usefulness of DOACs plasma levels “monitoring.”

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Edoxaban in elderly patient with morbid obesity and atrial fibrillation: the role of plasma levels evaluation for selecting the appropriate dose

Abstract: We present the case of a 80-year-old man with atrial fibrillation, morbid obesity (weight 123 kg, height 167 cm, BMI 44.1), high clearance of creatinine and pharmacological polytherapy, in which the serial determinations of edoxaban plasma levels help us to choose the appropriate dose.

Cited by 9 publications

References 17 publications

Gender Differences in Atrial Fibrillation: From the Thromboembolic Risk to the Anticoagulant Treatment Response

Gender Differences in Atrial Fibrillation: From the Thromboembolic Risk to the Anticoagulant Treatment Response

Antioxidant Properties of Oral Antithrombotic Therapies in Atherosclerotic Disease and Atrial Fibrillation

Direct Oral Anticoagulants Plasma Levels Measurement: Clinical Usefulness from Trials and Real-World Data

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