Efficacy and Safety of Direct Factor Xa Inhibitors Versus Warfarin in Prevention of Primary and Secondary Ischemic Strokes in Non-Valvular Atrial Fibrillation: A Literature Review

Emamy, Mina; Zahid, Tehrim; Ryad, Robert; Saad-Omer, Suhail M; Jahan, Nusrat

doi:10.7759/cureus.9400

Cited by 3 publications

(3 citation statements)

References 35 publications

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“…Emamy et al . [ 75 ] reported that the direct factor Xa inhibitor slightly reversed calcification in coronary arteries and heart valves, which was induced by warfarin and other vitamin K inhibitors. Yang et al .…”

Section: Discussionmentioning

confidence: 99%

“…Early clinical diagnosis, early intervention, and multidisciplinary approaches act in the prevention and treatment of VC induced by warfarin. Emamy et al [75] reported that the direct factor Xa inhibitor slightly reversed calcification in coronary arteries and heart valves, which was induced by warfarin and other vitamin K inhibitors. Yang et al [76] cultured HAVIC from patients with warfarin-induced aortic valve stenosis in a high inorganic phosphate medium, and showed that menaquinone-4 accelerated warfarin-induced calcification in HAVIC.…”

Section: Early Interventions and Multidisciplinary Treatment Strategiesmentioning

confidence: 99%

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Warfarin-Induced Calcification: Potential Prevention and Treatment Strategies

Wang¹,

Peng²,

Ma³

et al. 2022

Rev. Cardiovasc. Med.

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Warfarin is clinically used as the first choice for long-term anticoagulant therapy, and for the prevention of thromboembolic events. However, when used at low doses in the long term or high doses in the short term, warfarin treatment may result in tissue calcifications-such as calcifications in the coronary arteries, peripheral vascular system, blood vessels of patients with atrial fibrillation and chronic kidney disease, and vascular valves-and atherosclerotic plaque calcification. These warfarin-induced calcifications may affect cardiovascular function and exacerbate diseases such as diabetes and hypertension. Studies have shown that quercetin, osteoprotegerin, sclerosin, and sodium thiosulfate may alleviate these effects by interfering in the Wnt/β-catenin, TG2/β-catenin, Bone Morphogenetic Protein 2 (BMP2), and Eicosapentaenoic Acid/Matrix Metallopeptidase-9 (EPA/MMP-9) pathways, respectively. Nevertheless, the mechanism underlying warfarin-induced calcification remains unknown. Therefore, the question as to how to effectively attenuate the calcification induced by warfarin and ensure its anticoagulant effect remains an urgent clinical problem that needs to be resolved. To utilize warfarin rationally and to effectively attenuate the calcifications, we focused on the clinical phenomena, molecular mechanisms, and potential strategies to prevent calcification. Highlighting these aspects could provide new insights into the effective utilization of warfarin and the reduction of its associated calcification effects.

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Section: Discussionmentioning

confidence: 99%

Section: Early Interventions and Multidisciplinary Treatment Strategiesmentioning

confidence: 99%

Warfarin-Induced Calcification: Potential Prevention and Treatment Strategies

Wang¹,

Peng²,

Ma³

et al. 2022

Rev. Cardiovasc. Med.

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“…However, the safety of warfarin in patients on dialysis is questioned as it may cause a higher incidence of bleeding. Additionally, the efficacy of warfarin in stroke prevention among patients with AF who are on dialysis is debatable 6 . Direct oral anticoagulant agents (DOACs) have been proved to have comparative efficacy and safety profiles as warfarin in reducing the risk of thromboembolic stroke and they are currently widely used in many patient groups.…”

Section: Introductionmentioning

confidence: 99%

Safety and Effectiveness of Direct Xa Inhibitors vs Warfarin in Patients with Nephrotic Syndrome

Shahjahan¹,

Ahmed²,

Jamal³

2022

PJMHS

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Introduction: Nephrotic syndrome (NS) is characterized by excessive proteinuria (> 3.5 g/day), hypoalbuminemia, and edema. Objectives: The main objective of the study is to find the safety and effectiveness of direct Xa inhibitors vs warfarin in patients with nephrotic syndrome. Material and methods: This cross-sectional study was conducted in Akbar Niazi Teaching Hospital, Barakahu, Islamabad from January 2022 till June 2022. The data were collected from 120 patients which diagnosed with nephrotic syndrome. After permission from hospital ethical committee, total 120 patients meeting the inclusion and exclusion criteria was enrolled in the study. Detailed history of kidney disease and physical examination was done to meet the inclusion and exclusion criteria. Informed consent was obtained. Results: The data was collected from 120 patients. Out of 120 participants, 60 were treated with warfarin while 60 were considered as control group. Median age was 26 years in group I and 25.3 years in group II (p=0.705). Female cases counted for 41 (86%) and 19 (14%) in I and II groups, respectively. Risk factors, clinical presentation, affected vessels and AF for both groups are depicted in Table I. Results from both groups were comparable and statistically, no significant differences were observed (p• value more than 0.05). Practical implication: This study will help in treating nephrotic syndrome and kidney complications. Conclusion: It is concluded that awareness about nephrotic syndrome in patients were low and its prevalence continues to remain high and is likely to increase globally. Direct Xa inhibitors were associated with lower hazards of kidney complications and mortality than warfarin in patients with nephrotic syndrome. Keywords: Nephrotic, Syndrome, Complications, Mortality, Warfarin

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Direct Oral FXa Inhibitors Binding to Human Serum Albumin: Spectroscopic, Calorimetric, and Computational Studies

Mariño-Ocampo

proyectos

Díaz

et al. 2023

IJMS

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Direct FXa inhibitors are an important class of bioactive molecules (rivaroxaban, apixaban, edoxaban, and betrixaban) applied for thromboprophylaxis in diverse cardiovascular pathologies. The interaction of active compounds with human serum albumin (HSA), the most abundant protein in blood plasma, is a key research area and provides crucial information about drugs’ pharmacokinetics and pharmacodynamic properties. This research focuses on the study of the interactions between HSA and four commercially available direct oral FXa inhibitors, applying methodologies including steady-state and time-resolved fluorescence, isothermal titration calorimetry (ITC), and molecular dynamics. The HSA complexation of FXa inhibitors was found to occur via static quenching, and the complex formation in the ground states affects the fluorescence of HSA, with a moderate binding constant of 104 M−1. However, the ITC studies reported significantly different binding constants (103 M−1) compared with the results obtained through spectrophotometric methods. The suspected binding mode is supported by molecular dynamics simulations, where the predominant interactions were hydrogen bonds and hydrophobic interactions (mainly π–π stacking interactions between the phenyl ring of FXa inhibitors and the indole moiety of Trp214). Finally, the possible implications of the obtained results regarding pathologies such as hypoalbuminemia are briefly discussed.

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Efficacy and Safety of Direct Factor Xa Inhibitors Versus Warfarin in Prevention of Primary and Secondary Ischemic Strokes in Non-Valvular Atrial Fibrillation: A Literature Review

Cited by 3 publications

References 35 publications

Warfarin-Induced Calcification: Potential Prevention and Treatment Strategies

Warfarin-Induced Calcification: Potential Prevention and Treatment Strategies

Safety and Effectiveness of Direct Xa Inhibitors vs Warfarin in Patients with Nephrotic Syndrome

Direct Oral FXa Inhibitors Binding to Human Serum Albumin: Spectroscopic, Calorimetric, and Computational Studies

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