The Non-Vitamin K Antagonist Oral Anticoagulants in Heart Disease: Section V-Special Situations.

Abstract

Non-vitamin K antagonist oral anticoagulants (NOACs) include dabigatran, which inhibits thrombin, and apixaban, betrixaban, edoxaban and rivaroxaban, which inhibit factor Xa. In large clinical trials comparing the NOACs with the vitamin K antagonist (VKA) warfarin, dabigatran, apixaban, rivaroxaban and edoxaban were at least as effective for stroke prevention in atrial fibrillation and for treatment of venous thromboembolism, but were associated with less intracranial bleeding. In addition, the NOACs are more convenient to administer than VKAs because they can be given in fixed doses without routine coagulation monitoring. Consequently, the NOACs are now replacing VKAs for these indications, and their use is increasing. Although, as a class, the NOACs have a favourable benefit-risk profile compared with VKAs, choosing among them is complicated because they have not been compared in head-to-head trials. Therefore, selection depends on the results of the individual trials, renal function, the potential for drug-drug interactions and preference for once- or twice-daily dosing. In addition, several 'special situations' were not adequately studied in the dedicated clinical trials. For these situations, knowledge of the unique pharmacological features of the various NOACs and judicious cross-trial comparison can help inform prescription choices. The purpose of this position article is therefore to help clinicians choose the right anticoagulant for the right patient at the right dose by reviewing a variety of special situations not widely studied in clinical trials.

• Authors: Raffaele De Caterina, Walter Ageno, Giancarlo Agnelli, Noel C Chan, Hans-Christoph Diener, Elaine Hylek, Gary E Raskob, Deborah M Siegal, Freek W A Verheugt, Gregory Y H Lip, Jeffrey I Weitz
• Journal: Thrombosis and haemostasis (Thromb Haemost) Vol. 119 Issue 1 Pg. 14-38 (Jan 2019) ISSN: 2567-689X [Electronic] Germany
• PMID: 30597497 (Publication Type: Journal Article, Review)
• Copyright: Georg Thieme Verlag KG Stuttgart · New York.

Chemical References

• Antibodies, Monoclonal, Humanized
• Anticoagulants
• Benzamides
• Biomarkers
• PRT064445
• Piperazines
• Pyrazoles
• Pyridines
• Pyridones
• Recombinant Proteins
• Thiazoles
• Vitamin K
• apixaban
• Warfarin
• betrixaban
• Arginine
• idarucizumab
• Rivaroxaban
• Thrombin
• Factor Xa
• Dabigatran
• edoxaban
• PER977

Topics

• Administration, Oral
• Antibodies, Monoclonal, Humanized (therapeutic use)
• Anticoagulants (therapeutic use)
• Arginine (analogs & derivatives, therapeutic use)
• Atrial Fibrillation (prevention & control)
• Benzamides (therapeutic use)
• Biomarkers (metabolism)
• Blood Coagulation
• Clinical Trials as Topic
• Dabigatran (therapeutic use)
• Drug Administration Schedule
• Factor Xa (therapeutic use)
• Heart Diseases (complications, drug therapy)
• Humans
• Piperazines (therapeutic use)
• Pyrazoles (therapeutic use)
• Pyridines (therapeutic use)
• Pyridones (therapeutic use)
• Recombinant Proteins (therapeutic use)
• Risk
• Rivaroxaban (therapeutic use)
• Stroke (prevention & control)
• Thiazoles (therapeutic use)
• Thrombin (antagonists & inhibitors)
• Venous Thromboembolism (drug therapy)
• Vitamin K (antagonists & inhibitors)
• Warfarin (therapeutic use)