Article
Medicine, General & Internal
Gregory Y. H. Lip, Allison Keshishian, Yan Zhang, Amiee Kang, Amol D. Dhamane, Xuemei Luo, Christian Klem, Mauricio Ferri, Jenny Jiang, Huseyin Yuce, Steven Deitelzweig
Summary: In this study of patients with NVAF and high risk of GI bleed, NOACs were associated with lower rates of stroke and/or SE, but NOACs had varying risks of MB compared with warfarin. These results may help inform treatment options in this patient population.
Article
Medicine, General & Internal
Woldesellassie M. Bezabhe, Jan Radford, Barbara C. Wimmer, Mohammed S. Salahudeen, Ivan Bindoff, Gregory M. Peterson
Summary: The use of DOACs is associated with a lower risk of osteoporosis compared to warfarin, with each individual DOAC having a significantly lower risk as well.
JOURNAL OF CLINICAL MEDICINE
(2022)
Article
Cardiac & Cardiovascular Systems
Nijole Bernaitis, Tony Badrick, Shailendra Anoopkumar-Dukie
Summary: This study found that when patients with atrial fibrillation were switched from warfarin to a non-vitamin K oral anticoagulant (NOAC), the potential for pharmacokinetic (PK) drug interactions significantly reduced but remained around 40%. Identifying and managing potential PK drug interactions with NOACs remains a priority to optimize the clinical benefit of these anticoagulants.
JOURNAL OF THROMBOSIS AND THROMBOLYSIS
(2021)
Article
Pharmacology & Pharmacy
Shin-Yi Lin, Sung-Chun Tang, Ching-Hua Kuo, Li-Ting Ho, Yen-Bin Liu, Yu-Fong Peng, Li-Kai Tsai, Chih-Fen Huang, Jiann-Shing Jeng
Summary: This study reports on the association between direct oral anticoagulant (DOAC) concentration and clinical outcomes in Asian patients with atrial fibrillation (AF). The proportion of DOAC concentrations falling outside the expected range was higher than reported in clinical trials. Low trough concentration was associated with increased risk of systemic thromboembolism (SSE), while high trough concentration was associated with major bleeding. Measurement of trough DOAC concentration should be considered for patients at risk of concentration deviations.
CLINICAL PHARMACOLOGY & THERAPEUTICS
(2023)
Article
Multidisciplinary Sciences
Carla Moret, Rene Acosta-Isaac, Sergi Mojal, Mariana Corrochano, Blanca Jimenez, Melania Plaza, Juan Carlos Souto
Summary: The study found that direct oral anticoagulants (DOAC) are replacing vitamin K antagonists in preventing thromboembolism in atrial fibrillation patients. However, there are contradicting real-world clinical outcomes reported in different studies. This study presents a clinical model for DOAC management in clinical practice and reviews the literature.
Article
Cardiac & Cardiovascular Systems
M. Jansson, S. Sjalander, V Sjogren, F. Bjorck, H. Renlund, B. Norrving, A. Sjalander
Summary: This study compared the effectiveness and safety of reduced-dose direct oral anticoagulants (DOACs) and high-quality warfarin treatment in nonvalvular atrial fibrillation patients. The findings showed that compared to warfarin, DOACs have lower risks of major bleeding and all-cause stroke, with the exception of rivaroxaban, which has a higher risk of major bleeding and a lower risk of stroke or systemic embolism. Therefore, in patients with indications for reduced-dose DOACs, they are the preferred treatment option.
JOURNAL OF THROMBOSIS AND THROMBOLYSIS
(2023)
Article
Medicine, General & Internal
Anneka Mitchell, Julia Snowball, Tomas J. Welsh, Margaret C. Watson, Anita McGrogan
Summary: The study found a significant increase in the prescribing of oral anticoagulants for atrial fibrillation patients aged 75 years and older, but disparities still exist based on age and comorbidities. Elderly patients and those with comorbidities such as dementia, history of falls, major bleeds, and fractures were less likely to be prescribed oral anticoagulants.
Review
Economics
Charles Okafor, Joshua Byrnes, Simon Stewart, Paul Scuffham, Clifford Afoakwah
Summary: This study aimed to evaluate the cost effectiveness of treatment strategies to manage atrial fibrillation (AF) in adults living in low-, middle-, and high-income countries. The findings showed that different strategies were cost-effective in different resource settings. In high-income countries, apixaban and left atrial appendage closure were effective for stroke prevention, while propranolol, catheter ablation, and the convergent procedure were options for rate or rhythm control. In middle-income countries, apixaban and high-dose edoxaban were effective for stroke prevention, and radiofrequency catheter ablation was an option for rhythm control.
Article
Medicine, General & Internal
Agnieszka Kaplon-Cieslicka, Monika Gawalko, Monika Budnik, Beata Uzieblo-Zyczkowska, Pawel Krzesinski, Katarzyna Starzyk, Iwona Gorczyca-Glowacka, Ludmila Danilowicz-Szymanowicz, Damian Kaufmann, Maciej Wojcik, Robert Blaszczyk, Jaroslaw Hiczkiewicz, Katarzyna Lojewska, Katarzyna Mizia-Stec, Maciej T. Wybraniec, Katarzyna Kosmalska, Marcin Fijalkowski, Anna Szymanska, Miroslaw Dluzniewski, Maciej Haberka, Michal Kucio, Blazej Michalski, Karolina Kupczynska, Anna Tomaszuk-Kazberuk, Katarzyna Wilk-Sledziewska, Renata Wachnicka-Truty, Marek Kozinski, Pawel Burchardt, Piotr Scislo, Radoslaw Piatkowski, Janusz Kochanowski, Grzegorz Opolski, Marcin Grabowski
Summary: Atrial fibrillation and flutter increase the risk of left atrial thrombus. Chronic oral anticoagulation can reduce the prevalence of left atrial thrombus. The risk of left atrial thrombus appears to be higher with vitamin K antagonists compared to non-vitamin K antagonist oral anticoagulants, and similar among different non-vitamin K antagonist oral anticoagulants.
JOURNAL OF CLINICAL MEDICINE
(2022)
Article
Cardiac & Cardiovascular Systems
Amgad Mentias, Marwan Saad, Madonna Michael, Shady Nakhla, Venu Menon, Serge Harb, Pulkit Chaudhury, Douglas Johnston, Walid Saliba, Oussama Wazni, Lars Svensson, Milind Y. Desai, Samir Kapadia
Summary: Direct oral anticoagulants (DOACs) are associated with higher risk of ischemic stroke but lower risk of bleeding in patients with bioprosthetic valve replacement compared with warfarin, while DOACs are associated with lower risk of all three outcomes in patients with mitral valve repair in atrial fibrillation compared with warfarin.
JOURNAL OF THE AMERICAN HEART ASSOCIATION
(2022)
Article
Multidisciplinary Sciences
Giorgio Ciminata, Claudia Geue, Olivia Wu, Manuela Deidda, Noemi Kreif, Peter Langhorne
Summary: This study aimed to explore the methodological challenges of using real-world evidence (RWE) to estimate comparative effectiveness of anticoagulants in Scotland. The results showed that different methods, such as propensity score (PS) matching, inverse probability weighting (IPW), and covariate adjustment with PS, performed well in different subgroups of the study population.
Article
Medicine, General & Internal
Ajinkya Pawar, Joshua J. Gagne, Chandrasekar Gopalakrishnan, Geetha Iyer, Helen Tesfaye, Gregory Brill, Kristyn Chin, Katsiaryna Bykov
Summary: This study compares the outcomes of VTE patients using different drugs for oral anticoagulation therapy beyond 90 days, including hospitalization for recurrent VTE, major bleeding, and death. The results show that continuation of apixaban therapy beyond 90 days is associated with a significantly lower rate of recurrent VTE hospitalization compared to warfarin, but no significant difference is found between apixaban and rivaroxaban. There is no significant difference in the rate of hospitalization for major bleeding among the three drugs.
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION
(2022)
Review
Medicine, General & Internal
David Mocini, Stefania Angela Di Fusco, Edoardo Mocini, Lorenzo Maria Donini, Carlo Lavalle, Andrea Di Lenarda, Carmine Riccio, Pasquale Caldarola, Leonardo De Luca, Michele Massimo Gulizia, Fabrizio Oliva, Domenico Gabrielli, Furio Colivicchi
Summary: DOACs, including dabigatran, rivaroxaban, apixaban, and edoxaban, offer major advantages over VKAs, but concerns remain regarding potential undertreatment in obese patients without specific RCTs comparing the two. Despite limitations, the Italian Association of Hospital Cardiologists has proposed recommendations for the use of DOACs in obese patients based on existing evidence.
JOURNAL OF CLINICAL MEDICINE
(2021)
Article
Multidisciplinary Sciences
Carlos Escobar Cervantes, Julio Marti-Almor, Alejandro Isidoro Perez Cabeza, Kevin Bowrin, Aleix Llorac Moix, Mar Genis Girones, David Gasche, Aurelie Millier, Jean Tardu, Mondher Toumi, Jean-Baptiste Briere
Summary: Based on real-world data, rivaroxaban and dabigatran are cost-effective for stroke prevention in patients with non-valvular atrial fibrillation compared to vitamin K antagonist, while apixaban has a lower cost-effectiveness.
Article
Cardiac & Cardiovascular Systems
Che Ngufor, Xiaoxi Yao, Jonathan W. Inselman, Joseph S. Ross, Sanket S. Dhruva, David J. Graham, Joo-Yeon Lee, Konstantinos C. Siontis, Nihar R. Desai, Eric Polley, Nilay D. Shah, Peter A. Noseworthy
Summary: This study analyzed data from 34,569 patients with atrial fibrillation (AF) who were treated with oral anticoagulants. Using a machine learning method, the study identified differences in treatment effects among different patient subgroups. The findings suggest that the effectiveness of oral anticoagulants varies across subgroups of AF patients, which can help personalize medication choices.
AMERICAN HEART JOURNAL
(2023)