NOACs for treatment of venous thromboembolism in clinical practice

Schulman, Sam; Singer, Daniel E.; Ageno, Walter; Casella, Ivan Benaduce; Desch, Marc; Goldhaber, Samuel Z.

doi:10.1160/th17-01-0065

Cited by 18 publications

(13 citation statements)

References 42 publications

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“…In an analysis of Optum data, reduced dose rivaroxaban was associated with (nonsignificant) stroke risk compared to warfarin. [50] Interestingly, and similar to our analysis, that pattern was not seen for dabigatran or apixaban. There is a growing body of literature suggesting that inappropriate DOAC dosing is commonplace.…”

Section: Discussionsupporting

confidence: 88%

Oral anticoagulation therapy and subsequent risk of venous thromboembolism in atrial fibrillation patients

Lutsey

Norby

Zakai

et al. 2018

Current Medical Research and Opinion

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Objective: Oral anticoagulation (OAC) prescribed to AF patients for the prevention of cardioembolic complications likely has the added benefit of preventing venous thromboembolism (VTE). We evaluated, among AF patients who are anticoagulated, whether type of OAC was associated with subsequent VTE risk. Methods: Non-valvular AF patients prescribed OACs between 2010 and September 2015 were identified via the MarketScan administrative claims databases. OACs included warfarin and direct OACs (DOACs: dabigatran, rivaroxaban and apixaban). Incident VTE was defined by ICD-9-CM codes. Patients were matched on age, sex, CHA 2 DS 2-VASc and high-dimensional propensity scores. The final analysis included 117,912 AF patients. Results: 1,357 VTE events accrued over a mean follow-up of 484 days. In multivariableadjusted, propensity score-matched Cox models, relative to new users of warfarin, risk of incident VTE was lower among new users of dabigatran [hazard ratio (95% confidence interval): 0.55

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Section: Discussionsupporting

confidence: 88%

Oral anticoagulation therapy and subsequent risk of venous thromboembolism in atrial fibrillation patients

Lutsey

Norby

Zakai

et al. 2018

Current Medical Research and Opinion

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“…49,57 Moreover, optimal adherence is essential to ensure both efficacy and safety with anticoagulant therapy and adherence to OACs remains a challenge in clinical practice. 3,5,13 A recent study that assessed 12-month adherence and persistence with OACs reported adherence rates of 63.1 to 66.5% with NOACs, compared with 55.2% with VKAs, and persistence with NOACs of 61.4 to 78.7%, compared with 65.9% with VKAs. 4 Moreover, it demonstrated heterogeneity among different NOACs, possibility due to different regimens.…”

Section: Discussionmentioning

confidence: 99%

Satisfaction of Patients with Nonvitamin K Anticoagulants Compared to Vitamin K Antagonists: a Systematic Review and Meta-analysis

et al. 2020

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Objective To undertake a systematic review and meta-analysis to assess the satisfaction of patients receiving nonvitamin K anticoagulants (NOACs), compared with vitamin K antagonists (VKAs). Methods We searched CENTRAL, MEDLINE, Embase, and Clinicaltrials.gov for randomized controlled trials (RCTs) and observational studies. Two reviewers screened, extracted, and appraised data independently. We pooled data using a random-effects model. Outcome included treatment satisfaction, which was assessed by scores of Duke Anticoagulation Satisfaction Scale (DASS), Anticlot Treatment Scale (ACTS), Perception of Anticoagulant Treatment Questionnaire 2 (PACT-Q2), or Treatment Satisfaction Questionnaire for Medication version II (TSQM-VII) and their domains reported with 95% confidence intervals (95% CIs). We followed MOOSE and PRISMA guidelines. Results We included four RCTs and 16 observational studies, enrolling 18,684 participants overall. Compared with VKAs, treatment with NOACs improved the ACTS Burdens score by 4.21 points (95% CI: 2.99–5.43, I 2 = 95%, combined n = 6,180), and ACTS Benefits by 0.49 points (95% CI: 0.18–0.81, I 2 = 85%, combined n = 6,171). Switching from VKAs to NOACs improved the ACTS Burdens score by 5.33 points (95% CI: 3.53–7.14, combined n = 3,097). Compared with VKAs, treatment with NOACs improved the TSQM-VII Global Satisfaction score by 6.86 points (95% CI: 3.00–10.73, combined n = 5,535). Conclusion In patients with nonvalvular atrial fibrillation or venous thromboembolism, NOAC treatment is associated with greater satisfaction compared with VKAs. The switch from VKAs to NOACs was associated with improved patients' satisfaction. These effects were largely due to a lower degree of treatment burden with NOAC treatment.

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“…DOACs are now widely used in clinical practice, 18 19 and are included—together with warfarin—as the standard of care for VTE treatment in current guidelines. 7 Given the options of warfarin versus DOACs, when making decisions providers and patients take into consideration factors such as cost, priorities about specific adverse outcomes, convenience and patient preference.…”

Section: Introductionmentioning

confidence: 99%

Anticoagulant Preferences and Concerns among Venous Thromboembolism Patients

et al. 2018

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Background: Warfarin and direct oral anticoagulants (DOACs) are used for the initial treatment and secondary prevention of venous thromboembolism (VTE), and have similar efficacy. Patient concerns and preferences are important considerations when selecting an anticoagulant, yet are not well studied. Methods: VTE patients (n = 519) were surveyed from online sources [clotconnect.org, stoptheclot.org and National Blood Clot Alliance Facebook followers (n = 495)], and a hematology clinic in Vermont (n = 24). Results: Patients were 83% female and on average (±SD) 45.7 ± 13.1 years; 65% self-reported warfarin as their initial VTE treatment and 35% a DOAC. Proportions reporting being extremely concerned about the following outcomes were as follows: recurrent VTE 33%, major bleeding 21%, moderate bleeding 16%, all-cause death 29%. When asked about oral anticoagulant characteristics, patients strongly preferred anticoagulants that are reversible (53%), and for which blood drug levels can be monitored (30%). Lower proportions agreed with statements that regular blood testing is inconvenient (18%), that they are comfortable using the newest drug versus an established drug (15%), and that it is difficult to change their diet to accommodate their anticoagulant (17%). In multivariable-adjusted models, patients tended to have had as their initial treatment, and to currently be taking, the oral anticoagulant option they personally preferred. Discussion: Patients held the greatest concern for recurrent VTE and mortality, regardless of which treatment they were prescribed. Potential weaknesses of warfarin (e.g. dietary restrictions, regular monitoring) were generally not considered onerous, while warfarin’s advantages (e.g. ability to monitor) were viewed favorably.

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NOACs for treatment of venous thromboembolism in clinical practice

Cited by 18 publications

References 42 publications

Oral anticoagulation therapy and subsequent risk of venous thromboembolism in atrial fibrillation patients

Oral anticoagulation therapy and subsequent risk of venous thromboembolism in atrial fibrillation patients

Satisfaction of Patients with Nonvitamin K Anticoagulants Compared to Vitamin K Antagonists: a Systematic Review and Meta-analysis

Anticoagulant Preferences and Concerns among Venous Thromboembolism Patients

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