Management of bleeding or urgent interventions in patients treated with direct oral anticoagulants (DOACs) - 2017 management proposals in Poland

Pruszczyk, Piotr; Tomaszuk‐Kazberuk, Anna; Słowik, Agnieszka; Drwiła, Rafał; Rydzewska, Grażyna; Filipiak‬, Krzysztof J.; Gaciong, Zbigniew; Kaźmierczak, Jarosław; Marczyński, Wojciech; Windyga, Jerzy; Kobayashi, Adam; Stępińska, Janina

doi:10.20452/pamw.3995

Cited by 15 publications

(16 citation statements)

References 11 publications

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“…Moreover, the authors claim that warfarin treatment with proper therapeutic values of INR performs well, and should not be ruled out in favor of NOACs although NOACs according both to randomized trials and registries are safer than warfarin, because they cause significantly fewer major bleeding events and especially dramatically reduce the rate of intracranial bleeding [33] . Some NOACs even have their specific reversal agents -idarucizumab for dabigatran and andexanet alfa for rivaroxaban -which raises safety of the anticoagulant treatment especially in the case of life-threatening bleeding or emergency settings [34] . Although NOACs are nowadays the preferred therapeutic option according to European Society of Cardiology guidelines, patients with markedly reduced renal function, especially with eGFR < 30 ml/min, benefit from VKA treatment [35] .…”

Section: Discussionmentioning

confidence: 99%

Do patients with a history of systemic embolism have better compliance in International Normalized Ratio control?

Tomaszuk‐Kazberuk¹,

Łopatowska²,

Młodawska³

et al. 2019

Heart Beat

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Among patients with AF chronic anticoagulant therapy with vitamin K antagonists (VKA) is suboptimal. Unfortunately, history of thromboembolic events did not cause better international normalized ratio (INR) control. Patients with a history of systemic embolism and very high risk for thromboembolic complications more often had INR below the therapeutic range than the rest of the patients with AF. It can be partly explained by the fact that patients with very high thromboembolic risk at the same time usually have a high risk of bleeding. We may assume that patients with multiple factors associated with inadequate INR may not be ideal candidates for VKA therapy. These patients should be possibly considered for non-vitamin K antagonist oral anticoagulants (NOACs). Further efforts should be made in Poland to improve the quality of antithrombotic care in patients with AF treated with VKA.

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Section: Discussionmentioning

confidence: 99%

Do patients with a history of systemic embolism have better compliance in International Normalized Ratio control?

Tomaszuk‐Kazberuk¹,

Łopatowska²,

Młodawska³

et al. 2019

Heart Beat

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“…Despite the higher risk of ischaemic stroke and peripheral emboli according to CHA 2 DS 2 VASc score the use of oral anticoagulation therapy in CKD group was significantly less frequent. The therapy in the group with AF, CAD and CKD was complex, it consisted of oral anticoagulants including NOACs (Non-Vitamin K Antagonist Oral Anticoagulants) and antiplatelet agents which raised the risk of bleeding that is why physicians were cautious about using antithrombotic drugs [43]. NOACs are preferable option for patients with moderate renal failure as they cause less major bleedings and some of them have specific reversal agents in case of life-threating bleedings or the need of urgent procedures [44].…”

Section: Discussionmentioning

confidence: 99%

Patients with Atrial Fibrillation and Chronic Kidney Disease More Often Undergo Angioplasty of Left Main Coronary Artery – a 867 Patient Study

Tomaszuk‐Kazberuk

Nikas

Łopatowska

et al. 2018

Kidney Blood Press Res

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Background/Aims: Several studies have implicated atrial fibrillation (AF) as a contributing factor in chronic kidney disease (CKD) and cardiovascular events. The prevalence of coronary artery disease (CAD) in patients with AF varies substantially from 17% to 46.5%. There are only few studies concerning renal function in population with AF undergoing coronary angiography. The aim of the present study was to assess which type of AF is dominant in CKD population scheduled for coronary angiography and if it can influence patients’ outcome, the association between renal impairment and the type of coronary procedures in AF patients and the influence of renal function on in-hospital mortality. Methods: We retrospectively studied 867 patients with AF hospitalized due to coronary angiography in two year time. The cut off value of CKD was eGFR ≤ 60 ml/min./1.73m² evaluated by CKD-EPI formula. Results: A total of 867 patients with AF (44% women; mean age 72±10 years) were included in the analysis. The mean eGFR was 44±11ml/min./1.73m² in patients with CKD and 89±18 ml/min./1.73m² in patients with preserved renal function. Patients with CKD and AF were older (p< 0.001), had more often diabetes (p=0.009), heart failure (p< 0.001) and anaemia (p< 0.001). Patients with CKD and AF had more often permanent type of AF (p< 0.001). In CKD patients CHA₂DS₂VASc score was 4.3±1.5 and HAS-BLED score was 2.0±1.2 and it was significantly higher as compared to population with preserved renal function (p< 0.001, p=0.02, respectively). The use of oral anticoagulation was less frequent in CKD group (p< 0.001) although these patients had higher CHA₂DS₂VASc score. Patients with AF and CKD were more often admitted due to myocardial infarction (STEMI or NSTEMI) (p=0.02, p< 0.001, respectively) and more often underwent percutaneous coronary intervention (PCI) (p=0.01). Among coronary arteries the percutaneous coronary intervention (PCI) of left main artery was done more frequently in CKD patients (p=0.01). Among CKD population in-hospital mortality was significantly higher in patients with eGFR < 30 ml/min (p< 0.001). Conclusion: Patients with CKD had more often permanent type of AF. Percutaneous interventions of the left main coronary artery, the only elective procedures influencing patients’ prognosis, were done more frequently in CKD patients with AF. In-hospital mortality was significantly higher in patients with severe renal impairment. Despite the higher risk of ischaemic stroke in CKD group the use of oral anticoagulation therapy was significantly less frequent and the patients were deprived of the confirmed benefits of such treatment.

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“…Issues to consider include drug switching (in GI bleeding: from rivaroxaban or high--dose dabigatran to apixaban), dose reduction, or modification of concomitant therapy. 61 Recommendations on the management of bleeding in patients treated with NOACs are summarized in TABLE 8. 62 Bleeding during dual antiplatelet therapy with and without oral anticoagulation Patients with DAPT -related bleeding constitute a challenging population as there are no evidence -based guidelines from randomized clinical trials.…”

Section: Platelet Transfusionmentioning

confidence: 99%

Management of bleeding in patients hospitalized in the intensive cardiac care unit: expert opinion of the Association of Intensive Cardiac Care and Section of Cardiovascular Pharmacotherapy of the Polish Cardiac Society in cooperation with specialists in other fields of medicine

et al. 2019

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Management of bleeding or urgent interventions in patients treated with direct oral anticoagulants (DOACs) - 2017 management proposals in Poland

Cited by 15 publications

References 11 publications

Do patients with a history of systemic embolism have better compliance in International Normalized Ratio control?

Do patients with a history of systemic embolism have better compliance in International Normalized Ratio control?

Patients with Atrial Fibrillation and Chronic Kidney Disease More Often Undergo Angioplasty of Left Main Coronary Artery – a 867 Patient Study

Management of bleeding in patients hospitalized in the intensive cardiac care unit: expert opinion of the Association of Intensive Cardiac Care and Section of Cardiovascular Pharmacotherapy of the Polish Cardiac Society in cooperation with specialists in other fields of medicine

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