The new oral anticoagulants

García, David; Libby, Edward N.; Crowther, Mark

doi:10.1182/blood-2009-09-241851

Cited by 258 publications

(190 citation statements)

References 33 publications

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“…Whether new oral anticoagulants (e.g., rivaroxaban, dabigatran and apixaban) that have a lower potential for drug-drug interactions can be more safely used in elderly patients receiving multiple drug treatments should also be examined. 36 Our study has potential limitations. First, given that our cohort included patients with VTE only, our results may not be generalizable to other indications for anticoagulant treatment.…”

Section: Discussionmentioning

confidence: 98%

Polypharmacy is Associated with an Increased Risk of Bleeding in Elderly Patients with Venous Thromboembolism

et al. 2014

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BACKGROUND: Polypharmacy, defined as the concomitant use of multiple medications, is very common in the elderly and may trigger drug-drug interactions and increase the risk of falls in patients receiving vitamin K antagonists. OBJECTIVE: To examine whether polypharmacy increases the risk of bleeding in elderly patients who receive vitamin K antagonists for acute venous thromboembolism (VTE). DESIGN: We used a prospective cohort study. PARTICIPANTS: In a multicenter Swiss cohort, we studied 830 patients aged ≥ 65 years with VTE. MAIN MEASURES: We defined polypharmacy as the prescription of more than four different drugs. We assessed the association between polypharmacy and the time to a first major and clinically relevant non-major bleeding, accounting for the competing risk of death. We adjusted for known bleeding risk factors (age, gender, pulmonary embolism, active cancer, arterial hypertension, cardiac disease, cerebrovascular disease, chronic liver and renal disease, diabetes mellitus, history of major bleeding, recent surgery, anemia, thrombocytopenia) and periods of vitamin K antagonist treatment as a time-varying covariate. KEY RESULTS: Overall, 413 (49.8 %) patients had polypharmacy. The mean follow-up duration was 17.8 months. Patients with polypharmacy had a significantly higher incidence of major (9.0 vs. 4.1 events/100 patient-years; incidence rate ratio [IRR] 2.18, 95 % confidence interval [CI] 1.32-3.68) and clinically relevant nonmajor bleeding (14.8 vs. 8.0 events/100 patient-years; IRR 1.85, 95 % CI 1.27-2.71) than patients without polypharmacy. After adjustment, polypharmacy was significantly associated with major (sub-hazard ratio [SHR] 1.83, 95 % CI 1.03-3.25) and clinically relevant nonmajor bleeding (SHR 1.60, 95 % CI 1.06-2.42). CONCLUSIONS: Polypharmacy is associated with an increased risk of both major and clinically relevant nonmajor bleeding in elderly patients receiving vitamin K antagonists for VTE.

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Section: Discussionmentioning

confidence: 98%

Polypharmacy is Associated with an Increased Risk of Bleeding in Elderly Patients with Venous Thromboembolism

et al. 2014

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“…Of these, only lepiridin has a UK licence for this indication. Fondaparinux, an indirect FXa inhibitor, is licensed for prophylaxis in surgical and medical adult patients and the oral anticoagulants rivaroxaban and dabigatran are approved in Canada and Europe for prophylaxis following orthopaedic surgery (Garcia et al, 2010). None of these novel anticoagulant agents have a UK license for use in children.…”

Section: Novel Anticoagulant Agentsmentioning

confidence: 99%

Aspects of anticoagulation in children

Payne

2010

Br J Haematol

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SummaryThe number of children receiving anticoagulation is increasing. Thromboembolic events are associated with significant risk of morbidity and mortality although the optimal management of asymptomatic events remains unclear. Specific challenges in paediatrics include the diagnosis of thrombosis, delivery and monitoring of anticoagulation in a wide range of ages from neonates through to adolescents. The development of the haemostatic system as children age results in changing pathophysiology of thrombosis and response to anticoagulation agents. Although registry and observational studies have provided vital information, specific paediatric, prospective anticoagulation studies have been few and limited in design. The result is that much of current practice is extrapolated from adult studies. Traditional anticoagulants have significant limitations. Both heparin and warfarin are in widespread use but many fundamental questions regarding dose, therapeutic range, efficacy and optimum duration have not been fully answered. Alternative agents, such as direct thrombin inhibitors and the selective anti-factor Xa inhibitor fondaparinux, may have advantages for children. Clinical trials in adults and preliminary data in children are promising but caution should be applied until specific paediatric studies have demonstrated safety and efficacy.

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“…Further, these agents have been shown to have greater efficacy than enoxaparin in venous thromboembolism (VTE) prophylaxis post-orthopaedic surgery, with no increase in bleeding complications. [30][31][32][33][34] Both apixaban and rivaroxaban are now available through the Australian Pharmaceutical Benefits Scheme for this indication. There is also emerging evidence that factor Xa inhibitors and thrombin inhibitors, such as dabigatran are superior to warfarin in preventing stroke in the patients with atrial fibrillation (AF).…”

Section: Anticoagulation In Scleroderma Pahmentioning

confidence: 99%

Should patients with systemic sclerosis‐related pulmonary arterial hypertension be anticoagulated?

Nikpour

Stevens

Proudman

et al. 2013

Internal Medicine Journal

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Pulmonary arterial hypertension (PAH) is a major cause of mortality in scleroderma and despite 'advanced' therapies confers a median survival of less than 5 years. Anticoagulation in systemic sclerosis-related PAH (SSc-PAH) is currently one of the most contentious issues in the management of patients with connective tissue disease. While some studies have shown a survival benefit with warfarin therapy in this disease, others have not. Accordingly, a state of clinical equipoise exists in relation to anticoagulation in SSc-PAH. With an over fivefold reduction in mortality demonstrated in some observational studies, the issue of anticoagulation in SSc-PAH demands resolution through a well-designed randomised controlled trial.

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The new oral anticoagulants

Cited by 258 publications

References 33 publications

Polypharmacy is Associated with an Increased Risk of Bleeding in Elderly Patients with Venous Thromboembolism

Polypharmacy is Associated with an Increased Risk of Bleeding in Elderly Patients with Venous Thromboembolism

Aspects of anticoagulation in children

Should patients with systemic sclerosis‐related pulmonary arterial hypertension be anticoagulated?

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