Monitoring anticoagulant therapy with new oral agents

Ramos-Esquivel, Allan

doi:10.5662/wjm.v5.i4.212

Cited by 15 publications

(11 citation statements)

References 23 publications

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“…However, some studies report conflicting views in regard to the value of regular monitoring in NOAC therapy. [12][13][14][15] Limited access to, or unavailability of, specific antidotes for each of the NOACs, and their relatively higher drug costs, have raised additional considerations about their use among clinicians, patients, and wider health care systems. [16][17][18][19][20][21] The availability of NOACs has expanded the treatment armamentarium for stroke prevention in AF.…”

Section: Introductionmentioning

confidence: 99%

Contemporary utilization of antithrombotic therapy for stroke prevention in patients with atrial fibrillation: an audit in an Australian hospital setting

Pandya

Anderson

Chow

et al. 2017

Therapeutic Advances in Drug Safety

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Background: To document antithrombotic utilization in patients with nonvalvular atrial fibrillation (NVAF), particularly, recently approved NOACs (nonvitamin K antagonist oral anticoagulants) and warfarin; and identify factors predicting the use of NOACs versus warfarin. Methods: A retrospective audit was conducted in an Australian hospital. Data pertaining to inpatients diagnosed with atrial fibrillation (AF) admitted between January and December 2014 were extracted. This included patient demographics, risk factors (stroke, bleeding), social history, medical conditions, medication history, medication safety issues, medication adherence, and antithrombotic prescribed at admission and discharge. Results: Among 199 patients reviewed, 84.0% were discharged on antithrombotics. Anticoagulants (± antiplatelets) were most frequently (52.0%) prescribed (two-thirds were prescribed warfarin, the remainder NOACs), followed by antiplatelets (33.0%). Among 41 patients receiving NOACs, 59.0% were prescribed rivaroxaban, 24.0% dabigatran, and 17.0% apixaban. Among patients aged 75 years and over, antiplatelets were most frequently used (37.0%), followed by warfarin (33.0%), then NOACs (14.0%). Compared with their younger counterparts, patients aged 75 years and over were significantly less likely to receive NOACs (14.0% versus 28.0%, p = 0.01). Among the 'most eligible' patients (Congestive Cardiac Failure, Hypertension (, Age ⩾ 75 years, Age= 65-74 years, Diabetes Mellitus, Stroke/ Transient Ischaemic Attack/ Thromboembolism, Vascular disease, Sex female[CHA 2 DS 2-VASc] score ⩾2 and no bleeding risk factors), 46.0% were not anticoagulated on discharge. Patients with anaemia (68.0% versus 86.0%, p = 0.04) or a history of bleeding (65.0% versus 87.0%, p = 0.01) were less likely to receive antithrombotics compared with those without these risk factors. Warfarin therapy was less frequently prescribed among patients with cognitive impairment compared with patients with no cognitive issues (12.0% versus 23.0%, p = 0.01). Multivariate logistic regression modelling identified that patients with renal impairment were 3.6 times more likely to receive warfarin compared with NOACs (odds ratio = 3.6, 95% confidence interval = 0.08-0.90, p = 0.03, 60.0% correctly predicted; Cox and Snell R 2 = 0.51, Nagelkerke R 2 = 0.69). Conclusion: Despite the availability of NOACs, warfarin remains a preferred treatment option, particularly among patients with renal impairment. The high proportion of eligible patients still being prescribed antiplatelet therapy or 'no therapy' needs to be addressed.

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Section: Introductionmentioning

confidence: 99%

Contemporary utilization of antithrombotic therapy for stroke prevention in patients with atrial fibrillation: an audit in an Australian hospital setting

Pandya

Anderson

Chow

et al. 2017

Therapeutic Advances in Drug Safety

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“…Another problem is the great variety of absorption, body distribution, and metabolism of the agent with individual patients based on the pharmacokinetic properties of warfarin [30]. Frequent monitoring of therapeutic efficiency with adequate laboratory tools like prothrombin time (PT) or international normalized ratio (INR) is absolutely necessary [40,41] and a fixed or constant dose is close to impossible. Nevertheless, warfarin is highly effective in anticoagulation regiments when carefully dosing and assessing the potential bleeding sites as well as other potential side effects.…”

Section: Indications and Contraindicationsmentioning

confidence: 99%

From Rat Poison to Medicine: Medical Applications of Coumarin Derivatives

Bipat¹

2020

Phytochemicals in Human Health

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Historical reports mention the application of medicinal plants containing coumarins against various ailments. Current research suggests that at least some of the actions described may be attributable to the action of these coumarins. Warfarin and its derivatives are coumarins used today in medical practice. Their mechanism of action lies in the competitive antagonism of vitamin K, through which they inhibit coagulation in the body by preventing the production of prothrombin. Due to this action, these coumarins are a major group of drugs with anticoagulant activity. Anticoagulants reduce the risks of undesirable blood clots leading to myocardial infarction, pulmonary embolism, and ischemic stroke among others. The anticoagulant activity can also lead to undesired bleeding. Extreme caution is warranted when given to menstruating women, patients suffering from disorders prone to bleeding like gastric ulcer and rheumatoid arthritis, and to persons with a high likelihood of blunt and sharp trauma. In addition, there is a significant augmentation of the anticoagulant activity when used in combination with non-steroidal antiinflammatory agents and agents interfering with the metabolism of the coumarins. Recent findings propose additional uses like anti-tumor and antibiotic actions for coumarins. The clinical application of these actions has yet to be demonstrated.

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“…Apixaban was used in other similar cases with resolution of symptoms [6]. It started treatment with low doses of apixaban by the advanced age of the patient with the idea of preserving security [7].…”

Section: Sources Of Financingmentioning

confidence: 99%

Blue Finger Syndrome in an Elderly Patient

Castillo-Santizo¹,

Alvarez-Pérez²,

González‐López³

et al. 2018

J Fam Med Dis Prev

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This article presents a case of an 88-year-old man who shows blue-violaceous discoloration on his fingers and toes, with a greater intensity on the third finger of right hand and the first, second and third toe of his right foot. The patient had been recently diagnosed with atrial fibrillation and met the criteria for oral anticoagulation with acenocoumarol, which had started two weeks earlier. When the treatment was discontinued, the bluish color of his fingers disappeared, for which reason the patient was concluded to present a rare adverse effect to treatment with dicumarin, making it necessary to replace it for another anticoagulant with a different mechanism of action.

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Monitoring anticoagulant therapy with new oral agents

Cited by 15 publications

References 23 publications

Contemporary utilization of antithrombotic therapy for stroke prevention in patients with atrial fibrillation: an audit in an Australian hospital setting

Contemporary utilization of antithrombotic therapy for stroke prevention in patients with atrial fibrillation: an audit in an Australian hospital setting

From Rat Poison to Medicine: Medical Applications of Coumarin Derivatives

Blue Finger Syndrome in an Elderly Patient

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