Twice- or Once-Daily Dosing of Direct Oral Anticoagulants, a systematic review and meta-analysis

Mainbourg, Sabine; Cucherat, Michel; Provencher, Steeve; Bertoletti, Laurent; Nony, Patrice; Gueyffier, François; Mismetti, Patrick; Grangé, C.; Durieu, I.; Kilo, Roubi; Laporte, Silvy; Grenet, Guillaume; Lega, Jean‐Christophe

doi:10.1016/j.thromres.2020.10.011

Cited by 18 publications

(10 citation statements)

References 45 publications

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“…As adherence to DOACs is important for treatment success, prescribers should be aware of the potential implications of frequency of DOAC intake in relation to efficacy and safety of these agents. Particularly, as there seems not to be a difference in terms of efficacy and safety for once or twice-daily regimens [24].…”

Section: Discussionmentioning

confidence: 99%

Long-Term Adherence to Direct Oral Anticoagulants in Patients with Atrial Fibrillation: A Comparative Cross-Sectional Study

et al. 2022

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Background: Long-term treatment with direct oral anticoagulants (DOAC) is required for the majority of patients with non-valvular atrial fibrillation (AF) to prevent ischemic stroke and systemic embolism. Adherence to therapy may impact clinical outcomes. Therefore, the purpose of this study was to assess the potential impact of structured follow-up on long-term adherence to DOAC therapy compared to standard care. Methods: This is a cross sectional study on the implementation phase of medication adherence to DOACs, comparing patients with AF following completion of structured follow-up of minimally 1 year with those who received standard care. All patients used DOACs for more than two years and completed a questionnaire on adherence. Adherence was measured with the MMAS-8 score and assessed via an online webportal. Results: A total of 212 patients were included. The mean MMAS-8 score was 7.55(SD 0.93) after structured follow-up and 7.25(SD 1.01) for standard care; p=0.045. Following structured follow-up 64.1% of patients had a high adherence (MMAS score of 8) compared to 50% receiving standard care; p=0.05. Patients following structured follow-up on a once daily DOAC regime had higher MMAS-8 scores compared to those on a twice daily regime; 7.74(SD 0.74) vs. 7.00(SD 1.22); p<0.001. The rates of minor bleedings were 10.6% versus 21.4% respectively, p=0.038. Conclusion: In patients on long-term DOAC treatment, adherence to therapy was significantly increased after receiving an initial period of structured follow-up compared to standard care. Additionally, adherence to DOAC therapy was higher with once-daily treatment regimen. Significant more minor bleedings were reported in the standard care group. . These results indicate that implementation of structured follow-up of patients with AF using DOACs merits further evaluation.

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Section: Discussionmentioning

confidence: 99%

Long-Term Adherence to Direct Oral Anticoagulants in Patients with Atrial Fibrillation: A Comparative Cross-Sectional Study

et al. 2022

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“…However, comparative studies never found differences in effectiveness of preventing AIS among the two classes, which interact at different key points in the same pathway [ 5 , 12 ], so the individual patient’s response to the respective mechanism might be considered here. Likewise, the dose regimen (once versus twice daily intake), which may play a role in the switch from one to another DOAC, did not yield a difference in effectiveness in preventing thromboembolic events [ 28 ]. The presence of a specific antidote was important for almost half of respondents in the context of DOAC switching.…”

Section: Discussionmentioning

confidence: 99%

Treatment standards for direct oral anticoagulants in patients with acute ischemic stroke and non-valvular atrial fibrillation: A survey among German stroke units

et al. 2022

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Background Acute ischemic stroke (AIS) in patients with non-valvular atrial fibrillation (AF) despite oral anticoagulation (OAC) is a complex and insufficiently investigated setting. Potential strategies range from maintaining the current OAC to changing the substance class. We have queried the specific treatment standards on German stroke units (SUs). Methods By means of a standardized online questionnaire via SurveyMonkey™ (San Mateo, CA, USA), all clinical heads of German SUs were asked about their treatment standards in the following clinical situations: first AIS of an OAC-naïve AF patient, AF patient with AIS despite administration of a vitamin K antagonist (VKA), AF patient with AIS despite administration of direct OAC (DOAC). In addition, the performance of specific coagulation tests in AF patients with AIS despite OAC was queried. Results 160 (48%) clinical heads of German SU responded. Data from pivotal trials (84%), own experience with substances (71%), and side-effect profiles (66%) determine the initial DOAC prescription. In case of an AIS despite OAC, 83 and 18% would switch from VKA to DOAC under certain conditions and always, respectively. Half of respondents would switch from DOAC to VKA under certain conditions, while the other half would decline. 96% would switch to an alternative DOAC. The vast majority of those who made preconditions considered concomitant diseases (92, 90, and 81%, respectively). Few would consider infarct pattern (<35%). 61% perform initial coagulation tests (only one-third substance-specific assessments); however, the majority do not use these to make further decisions. Conclusions In the setting of an OAC-naïve AF patient with AIS, established pivotal data are most respected. In the unclear setting of an AIS despite OAC, most respondents consider concomitant diseases and give preference to switching to a (different) DOAC.

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“…A study by Mainbourg S and associates that examined the use of NOACs (apixaban, edoxaban, rivaroxaban and dabigatran) in different dosage regimens and analyzed whether the dosage method correlates with the occurrence of thrombogenic events. There was no difference for major thrombotic event (RR BID/QD = 1.06, 95%IC 0.86-1.30) nor for major bleeding (RR BID/QD = 1.02, 95%IC 0.84-1.23) between NOACs that were dosed twice daily or once a day, without heterogeneity (I2 = 0%) [129]. If oral anticoagulation continues after 3 months of PE in a patient without cancer, after 6 months of therapy, consider reducing the NOAC dose: apixaban (2.5 mg daily) or rivaroxaban (10 mg daily).…”

Section: Edoxabanmentioning

confidence: 94%

Dilemmas in the Choice of Adequate Therapeutic Treatment in Patients with Acute Pulmonary Embolism - from Modern Recommendations to Clinical Application

Lasica¹,

Ašanin²,

Djukanovic³

et al. 2022

Preprint

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Pulmonary thromboembolism is a very common cardiovascular disease, with a still high mortality rate. Despite the clear guidelines, this disease still represents a great challenge both in diagnosis and treatment. Heterogeneous clinical picture, often without pathognomonic signs and symptoms, represents a huge differential diagnostic problem even for experienced doctors. The decision on the therapeutic regimen also represents a major dilemma in the group of patients who are hemodynamically stable at initial presentation and have signs of right ventricular (RV) dysfunction proven by echocardiography and positive biomarker values (pulmonary embolism of intermediate-high risk). Studies have shown conflicting results about the benefit of using fibrinolytic therapy in this group of patients until hemodynamic decompensation, due to the risk of major bleeding. The latest recommendations give preference to new oral anticoagulants (NOACs) compared to vitamin K antagonists (VKA), except for certain categories of patients (patients with antiphospholipid syndrome, mechanical valves, pregnancy). When using oral anticoagulant therapy, special attention should be paid to drug-drug interactions, which can lead to many complications, even to the death of the patient. Special population groups such as pregnant women, obese patients, patients with antiphospholipid syndrome and cancer represent a great therapeutic challenge in the application of anticoagulant therapy. In these patients, not only the effectiveness of the drugs must be taken into account, but great attention must be paid to their safety and possible side effects, which is why a multidisciplinary approach is emphasized in order to provide the best therapeutic option.

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Twice- or Once-Daily Dosing of Direct Oral Anticoagulants, a systematic review and meta-analysis

Cited by 18 publications

References 45 publications

Long-Term Adherence to Direct Oral Anticoagulants in Patients with Atrial Fibrillation: A Comparative Cross-Sectional Study

Long-Term Adherence to Direct Oral Anticoagulants in Patients with Atrial Fibrillation: A Comparative Cross-Sectional Study

Treatment standards for direct oral anticoagulants in patients with acute ischemic stroke and non-valvular atrial fibrillation: A survey among German stroke units

Dilemmas in the Choice of Adequate Therapeutic Treatment in Patients with Acute Pulmonary Embolism - from Modern Recommendations to Clinical Application

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