Future directions of stroke prevention in atrial fibrillation: the potential impact of novel anticoagulants and stroke risk stratification

Cabral, Katherine P.; Ansell, Jack; Hylek, Elaine M.

doi:10.1111/j.1538-7836.2010.04179.x

Cited by 32 publications

(20 citation statements)

References 71 publications

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“…Dabigatran has minimal drug interactions and is excreted renally. 48 The Randomized Evaluation of Longterm anticoagulant therapY (RE-LY) study was a noninferiority trial that randomly assigned 18 113 patients to fixed doses of dabigatran (110 or 150 mg twice daily) or warfarin. Inclusion criteria were patients with documented AF with prior stroke or transient ischaemic attack, left ventricular ejection fraction less than 40%, New York Heart Association class II or higher or aged at least 75 years (patients aged 65 to 74 years with either diabetes, hypertension or coronary artery disease were also included).…”

Section: Direct Thrombin Inhibitormentioning

confidence: 99%

Anticoagulation for Non‐Valvular Atrial Fibrillation in Older People

Grewal

Farouque

2012

Pharmacy Practice and Res

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Atrial fibrillation (AF) is a common arrhythmia that increases in prevalence with advancing age. Systemic thromboembolism, a complication of AF and ischaemic stroke, is the most frequent clinical manifestation. The risk of stroke is increased in the presence of factors such as advancing age, heart failure, hypertension, diabetes and history of stroke. Long-term anticoagulation with warfarin has been the standard treatment for stroke prevention in patients with AF. In older people anticoagulation is associated with an increased risk of bleeding. Therefore, managing AF in older people can be a clinical challenge because not only are they at a high risk of thromboembolism but also of bleeding. Stroke risk stratification schemes have been developed to guide assessment of risks versus benefits. Other considerations in older people include monitoring anticoagulation, and assessing falls risk, compliance and the potential for drug interactions. A range of novel oral anticoagulants, such as direct thrombin inhibitors and factor Xa inhibitors, have been developed. These anticoagulants have demonstrated advantages in safety, efficacy and convenience of use in large randomised clinical trials. These novel anticoagulants could provide alternatives to warfarin for preventing stroke in older people with AF.

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Section: Direct Thrombin Inhibitormentioning

confidence: 99%

Anticoagulation for Non‐Valvular Atrial Fibrillation in Older People

Grewal

Farouque

2012

Pharmacy Practice and Res

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“…The Factor Xa inhibitor rivaroxaban is currently approved in Europe and Canada to prevent venous thromboembolism in the orthopedic patient population [Cabral et al 2010]. It has predictable pharmacokinetics and does not require monitoring (Table 1).…”

Section: Factor Xa Inhibitorsmentioning

confidence: 99%

“…Co-administration of rivaroxaban with other CYP3A4 substrates including atorvastatin and midazolam revealed no significant interactions, as did co-administration with P-glycoprotein substrate digoxin. Pharmacokinetic changes were appreciated when P-glycoprotein inhibitors such as verpamil, clarithromycin, quinidine and amiodarone were co-administered with dabigatran, however were not significant to change dosing recommendations [Cabral et al 2010].…”

Section: Reversibility and Drug Interactionsmentioning

confidence: 99%

New anticoagulants in atrial fibrillation: an update for clinicians

Bhusri¹,

Ansell²

2011

Therapeutic Advances in Chronic Disease

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Anticoagulation is vital for stroke and systemic embolism prevention in patients with atrial fibrillation. Current therapy with the vitamin K inhibitor warfarin has many inherent limitations in clinical practice. With the potential of broadening anticoagulation therapy to a larger population, new classes of anticoagulants have recently emerged with the potential for improved efficacy, safety and convenience. Direct thrombin inhibitor and Factor Xa inhibitor classes are showing promise for both patients and clinicians.

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“…1,2 However, warfarin use is challenged by its narrow therapeutic index, complex pharmacology and preventable adverse events. [3][4][5][6] Consequently, education for patients prescribed warfarin is critical to ensure optimum efficacy and medication safety.…”

Section: Introductionmentioning

confidence: 99%

Documentation of Warfarin Education provided to Hospital Patients: A Clinical Audit

Nasser

Cecchele²,

Touma³

et al. 2012

Pharmacy Practice and Res

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Background: Effective management of warfarin therapy is often challenged by its complex pharmacology and preventable adverse events. One strategy to ensure safe warfarin use is provision of comprehensive warfarin education to patients. Aim: To review the provision of warfarin education to hospital patients prescribed warfarin and to describe patient characteristics that may impact on warfarin education. Method: A prospective study was undertaken at 2 large Australian metropolitan hospitals. Provision of warfarin education was identified by auditing the medication charts and clinical notes of hospitalised older patients (≥ 65 years). Patients were also interviewed to confirm whether they recalled receiving warfarin education during their hospital stay. Results: Data were collected for 96 patients with a mean age of 74 (SD 13) years. Most patients (78%) were admitted to medical wards, were taking warfarin for atrial fibrillation (56%), and had started warfarin prior to admission (54%). 36% of patients had provision of warfarin education documented in medication charts and clinical notes, and in most cases warfarin education was provided by a pharmacist. Of the 68 patients available for interview, only 47% recalled receiving warfarin education; in the majority of cases they cited pharmacists as providers of the education. Conclusion: There is a need to improve documentation and provision of warfarin education to hospital patients.

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Future directions of stroke prevention in atrial fibrillation: the potential impact of novel anticoagulants and stroke risk stratification

Cited by 32 publications

References 71 publications

Anticoagulation for Non‐Valvular Atrial Fibrillation in Older People

Anticoagulation for Non‐Valvular Atrial Fibrillation in Older People

New anticoagulants in atrial fibrillation: an update for clinicians

Documentation of Warfarin Education provided to Hospital Patients: A Clinical Audit

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