Novel Anticoagulants in Atrial Fibrillation: Monitoring, Reversal and Perioperative Management

Shamoun, Fadi; Obeid, Hiba; Ramakrishna, Harish

doi:10.1155/2015/424031

Cited by 10 publications

(7 citation statements)

References 39 publications

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“…For operations with an increased risk for bleeding, NOACs should be preoperatively paused. The duration of the pause depends mainly on the patient’s renal function and the risk for perioperative bleeding (see Tables 4 and 5 ) [ 8 ], [ 19 ], [ 20 ], [ 21 ]. Certain medications prolong the half-life of NOACs, such as amiodarone and dronedarone, acetylsalicylic acid, nonsteroidal anti-inflammatory drugs, phenothiazine, verapamil, diltiazem, ketoconazole, fluconazole, macrolides, and HIV protease inhibitors.…”

Section: Perioperative Handlingmentioning

confidence: 99%

Perioperative management of anticoagulant therapy

Wagner

Lock

Kastner

et al. 2019

Innovative Surgical Sciences

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About 10% of patients taking a chronic, oral anticoagulant therapy require an invasive procedure that can be associated with an increased risk for peri-interventional or perioperative bleeding. Depending on the risk for thromboembolism and the risk for bleeding, the physician has to decide whether the anticoagulant therapy should be interrupted or continued. Patient characteristics such as age, renal function and drug interactions must be considered. The perioperative handling of the oral anticoagulant therapy differs according to the periprocedural bleeding risk. Patients requiring a procedure with a minor risk for bleeding do not need to pause their anticoagulant therapy. For procedures with an increased risk for perioperative bleeding, the anticoagulant therapy should be adequately paused. For patients on a coumarin derivative with a high risk for a thromboembolic event, a perioperative bridging therapy with a low molecular weight heparin is recommended. Due to an increased risk for perioperative bleeding in patients on a bridging therapy, it is not recommended in patients with a low risk for thromboembolism. For patients taking a non-vitamin K oral anticoagulant, a bridging therapy is not recommended due to the fast onset and offset of the medication.

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Section: Perioperative Handlingmentioning

confidence: 99%

Perioperative management of anticoagulant therapy

Wagner

Lock

Kastner

et al. 2019

Innovative Surgical Sciences

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“…Dabigatran is contraindicated in patients with CrCl <15 mL/min or in patients who are taking P-glycoprotein inhibitors with CrCl <30 mL/min. 6 Idarucizumab is a humanized monoclonal antibody fragment, derived from an immunoglobulin G-isotype molecule, which reverses the anticoagulant effects of dabigatran. …”

Section: Dabigatranmentioning

confidence: 99%

“…The absolute bioavailability of dabigatran, after oral administration, is around 6.5% (serum halflife, 12-17 hr), which warrants twice-daily dosing. 6 Renal excretion is the primary route of elimination of dabigatran (80%). The approved doses of dabigatran in the U.S. are 150 mg twice daily in patients with normal renal function and 75 mg twice daily both in patients with poor renal function (creatinine clearance [CrCl], 15-30 mL/min) and in patients with CrCl 30-50 mL/min in the presence of P-glycoprotein inhibitors.…”

mentioning

confidence: 99%

What's New in Anticoagulation

Razavi¹,

Safavi‐Naeini²,

Razavi³

2016

Texas Heart Institute Journal

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A trial fibrillation (AF), the most prevalent type of arrhythmia, affects an estimated 2.7 to 6.1 million people in the United States.1 Patients with AF are at a 4 to 5 times higher risk of stroke, and AF accounts for 15% to 20% of ischemic strokes in the U.S. Strokes related to AF are more severe than are strokes caused by other underlying disease.2 For many years, warfarin (vitamin K antagonist) has been the mainstay treatment of AF-related stroke. Warfarin is highly effective in reducing the risk of AF-related stroke but has substantial limitations that can outweigh those advantages-including a narrow therapeutic window and certain drug-drug and drug-food interactions.3 To overcome these limitations, recent years have seen the production of new oral anticoagulants (NOACs), such as factor Xa (rivaroxaban, apixaban, and edoxaban) inhibitors and direct thrombin inhibitors (dabigatran). Table I WarfarinWarfarin, introduced in 1954, is very effective in preventing AF-related strokes. Warfarin is reversible and inexpensive, and anticoagulation with warfarin (international normalized ratio, 2-3; mean, 2.5) has been shown to decrease AF-related stroke risk by 67%. However, warfarin still remains underused by about 50% of suitable candidates receiving treatment for AF. Warfarin therapy has some limitations, such as a slow onset of action, genetic variation in metabolism, multiple food and drug interactions, and a narrow therapeutic index that makes it difficult to use in practice.5 Therefore, there is a need in AF management for novel approaches to stroke prevention with NOACs. DabigatranDabigatran is a selective and reversible, oral, direct thrombin inhibitor. The absolute bioavailability of dabigatran, after oral administration, is around 6.5% (serum halflife, 12-17 hr), which warrants twice-daily dosing. 6 Renal excretion is the primary route of elimination of dabigatran (80%). The approved doses of dabigatran in the U.S. are 150 mg twice daily in patients with normal renal function and 75 mg twice daily both in patients with poor renal function (creatinine clearance [CrCl], 15-30 mL/min) and in patients with CrCl 30-50 mL/min in the presence of P-glycoprotein inhibitors. Dabigatran is contraindicated in patients with CrCl <15 mL/min or in patients who are taking P-glycoprotein inhibitors with CrCl <30 mL/min.6 Idarucizumab is a humanized monoclonal antibody fragment, derived from an immunoglobulin G-isotype molecule, which reverses the anticoagulant effects of dabigatran. RivaroxabanRivaroxaban is an oral, direct factor Xa inhibitor with a bioavailability of 70% and a serum half-life of 5 to 9 hours in healthy volunteers and 11 to 13 hours in the elderly. Two thirds of a rivaroxaban dose undergoes metabolic degradation in the liver, of which half is eliminated renally and half is removed via the hepatobiliary route in the feces. 4 The influence of renal function on rivaroxaban is considered to be moderate, and rivaroxaban is prescribed at oral dosages of 20 mg/d with evening meals (if CrCl >50 mL/min) or 15 mg/d...

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“…No need to supervise the treatment, fixed dose and simple use (that does not require the assessment of coagulation parameters) are definitely the advantages of new anticoagulants [17][18][19][20]. Another unquestionable advantage is a potentially greater possibility of ensuring proper and stable anticoagulation level with the use of new anticoagulants.…”

mentioning

confidence: 99%

“…Of course, it is necessary to take appropriate safety measures, especially in the scope of the evaluation of renal function as well as current risk of bleeding, just like in any other clinical situation associated with the anticoagulant therapy [7][8][9][10][18][19][20]. In case of renal function evaluation, one should take into account both baseline parameters of renal function and its possible changes during further treatment [7-10, 20, 22, 23].…”

mentioning

confidence: 99%