New oral anticoagulants: their advantages and disadvantages compared with vitamin K antagonists in the prevention and treatment of patients with thromboembolic events.
Reads0
Chats0
TLDR
The main objective of this study is to present recent data on non-vitamin K antagonist oral anticoagulants (NOACs) and to analyze their advantages and disadvantages compared with those of VKAs based on a large number of recent studies.Abstract:
Despite the discovery and application of many parenteral (unfractionated and low-molecular-weight heparins) and oral anticoagulant vitamin K antagonist (VKA) drugs, the prevention and treatment of venous and arterial thrombotic phenomena remain major medical challenges. Furthermore, VKAs are the only oral anticoagulants used during the past 60 years. The main objective of this study is to present recent data on non-vitamin K antagonist oral anticoagulants (NOACs) and to analyze their advantages and disadvantages compared with those of VKAs based on a large number of recent studies. NOACs are novel direct-acting medications that are selective for one specific coagulation factor, either thrombin (IIa) or activated factor X (Xa). Several NOACs, such as dabigatran (a direct inhibitor of FIIa) and rivaroxaban, apixaban and edoxaban (direct inhibitors of factor Xa), have been used for at least 5 years but possibly 10 years. Unlike traditional VKAs, which prevent the coagulation process by suppressing the synthesis of vitamin K-dependent factors, NOACs directly inhibit key proteases (factors IIa and Xa). The important indications of these drugs are the prevention and treatment of deep vein thrombosis and pulmonary embolisms, and the prevention of atherothrombotic events in the heart and brain of patients with acute coronary syndrome and atrial fibrillation. They are not fixed, and dose-various strengths are available. Most studies have reported that more advantages than disadvantages for NOACs when compared with VKAs, with the most important advantages of NOACs including safety issues (ie, a lower incidence of major bleeding), convenience of use, minor drug and food interactions, a wide therapeutic window, and no need for laboratory monitoring. Nonetheless, there are some conditions for which VKAs remain the drug of choice. Based on the available data, we can conclude that NOACs have greater advantages and fewer disadvantages compared with VKAs. New studies are required to further assess the efficacy of NOACs.read more
Citations
More filters
Journal ArticleDOI
U.S. FDA Approved Drugs from 2015-June 2020: A Perspective
Priyadeep Bhutani,Priyadeep Bhutani,Gaurav Joshi,Nivethitha Raja,Namrata Bachhav,Prabhakar Rajanna,Hemant Bhutani,Atish T. Paul,Raj Kumar +8 more
TL;DR: In this paper, the authors report compilation and analysis of 245 drugs, including small and macromolecules approved by the U.S. FDA from 2015 until June 2020, and they report that nearly 29% of the drugs were approved for the treatment of various types of cancers.
Journal ArticleDOI
Pharmacogenomics of Novel Direct Oral Anticoagulants: Newly Identified Genes and Genetic Variants
Sri H. Kanuri,Rolf P. Kreutz +1 more
TL;DR: An extensive search of recently published research articles including clinical trials and in-vitro studies in PubMed concludes that some of the inter-individual variability of DOACs can be attributed to alteration of genetic variants of gene loci and drug-drug interactions.
Journal ArticleDOI
Adherence to oral anticoagulants among patients with atrial fibrillation: a systematic review and meta-analysis of observational studies.
Shahrzad Salmasi,Peter Loewen,Rachel Tandun,Jason G. Andrade,Jason G. Andrade,Mary A. De Vera +5 more
TL;DR: It is shown that up to 30% of patients with AF are non-adherent, suggesting an important therapeutic challenge in this patient population, and higher medical costs compared with patients with poor adherence.
Journal ArticleDOI
Recent advances in the discovery and development of factor XI/XIa inhibitors
TL;DR: Chemical, biochemical, and pharmacological aspects of FXI/FXIa inhibitors are highlighted to develop a new generation of anticoagulants to effectively prevent and/or treat thromboembolic diseases without the life‐threatening risk of internal bleeding.
Journal ArticleDOI
Safety of 4-factor prothrombin complex concentrate (4F-PCC) for emergent reversal of factor Xa inhibitors.
TL;DR: The thromboembolic rate of 4F-PCC when given at a dose of 25–50 IU/kg to emergently reverse rivaroxaban and apixaban appears acceptable, and practitioners should be highly vigilant of these complications.
References
More filters
Journal ArticleDOI
Dabigatran versus warfarin in patients with atrial fibrillation
Stuart J. Connolly,Michael D. Ezekowitz,John W. Eikelboom,Jonas Oldgren,Amit Parekh,Janice Pogue,Paul A. Reilly,Ellison Themeles,Jeanne Varrone,Susan Wang,Marco Alings,Denis Xavier,Jun Zhu,Rafael Diaz,Basil S. Lewis,Harald Darius,Hans-Christoph Diener,Campbell D. Joyner,Lars Wallentin +18 more
TL;DR: In patients with atrial fibrillation, dabigatran given at a dose of 110 mg was associated with rates of stroke and systemic embolism that were similar to those associated with warfarin, as well as lower rates of major hemorrhage.
Journal ArticleDOI
Rivaroxaban versus Warfarin in Nonvalvular Atrial Fibrillation
Manesh R. Patel,Kenneth W. Mahaffey,Jyotsna Garg,Guohua Pan,Daniel E. Singer,Werner Hacke,Günter Breithardt,Jonathan L. Halperin,Graeme J. Hankey,Jonathan P. Piccini,Richard C. Becker,Christopher C. Nessel,John F. Paolini,Scott D. Berkowitz,Robert M. Califf +14 more
TL;DR: In patients with atrial fibrillation, rivaroxaban was noninferior to warfarin for the prevention of stroke or systemic embolism and there was no significant between-group difference in the risk of major bleeding, although intracranial and fatal bleeding occurred less frequently in the rivroxaban group.
Journal ArticleDOI
Apixaban versus Warfarin in Patients with Atrial Fibrillation
Christopher B. Granger,John H. Alexander,Renato D. Lopes,Elaine M. Hylek,Michael G. Hanna,Hussein R. Al-Khalidi,Jack Ansell,Dan Atar,Alvaro Avezum,M. Cecilia Bahit,Rafael Diaz,J. Donald Easton,Justin A. Ezekowitz,Greg C. Flaker,David A. Garcia,Margarida Geraldes,Bernard J. Gersh,Sergey P. Golitsyn,Shinya Goto,Antonio G. Hermosillo,Stefan H. Hohnloser,John D. Horowitz,Puneet Mohan,Petr Jansky,Basil S. Lewis,Jose Lopez-Sendon,Prem Pais,Alexander Parkhomenko,Jun Zhu,Lars Wallentin +29 more
TL;DR: In patients with atrial fibrillation, apixaban was superior to warfarin in preventing stroke or systemic embolism, caused less bleeding, and resulted in lower mortality.
Journal ArticleDOI
Oral rivaroxaban for symptomatic venous thromboembolism
Rupert Bauersachs,Scott D. Berkowitz,Benjamin Brenner,Harry R. Buller,Hervé Decousus,Alexander Gallus,Anthonie W. A. Lensing,Frank Misselwitz,Martin H. Prins,Gary E. Raskob,Annelise Segers,Peter Verhamme,Phil Wells,Giancarlo Agnelli,Henri Bounameaux,Alexander T. Cohen,Bruce L. Davidson,Franco Piovella,Sebastian Schellong +18 more
TL;DR: Rivaroxaban offers a simple, single-drug approach to the short-term and continued treatment of venous thrombosis that may improve the benefit-to-risk profile of anticoagulation.
Journal ArticleDOI
Dabigatran versus warfarin in the treatment of acute venous thromboembolism
Sam Schulman,Clive Kearon,Ajay K. Kakkar,Patrick Mismetti,Sebastian Schellong,Henry Eriksson,David Baanstra,Janet Schnee,Samuel Z. Goldhaber,S. Schul +9 more
TL;DR: For the treatment of acute venous thromboembolism, a fixed dose of dabigatran is as effective as warfarin, has a safety profile that is similar to that of warfar in, and does not require laboratory monitoring.
Related Papers (5)
Rivaroxaban versus Warfarin in Nonvalvular Atrial Fibrillation
Dabigatran versus warfarin in patients with atrial fibrillation
Apixaban versus Warfarin in Patients with Atrial Fibrillation
Christopher B. Granger,John H. Alexander,Renato D. Lopes,Elaine M. Hylek,Michael G. Hanna,Hussein R. Al-Khalidi,Jack Ansell,Dan Atar,Alvaro Avezum,M. Cecilia Bahit,Rafael Diaz,J. Donald Easton,Justin A. Ezekowitz,Greg C. Flaker,David A. Garcia,Margarida Geraldes,Bernard J. Gersh,Sergey P. Golitsyn,Shinya Goto,Antonio G. Hermosillo,Stefan H. Hohnloser,John D. Horowitz,Puneet Mohan,Petr Jansky,Basil S. Lewis,Jose Lopez-Sendon,Prem Pais,Alexander Parkhomenko,Jun Zhu,Lars Wallentin +29 more
2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS
Paulus Kirchhof,Stefano Benussi,Dipak Kotecha,Anders Ahlsson,Dan Atar,Barbara Casadei,Manuel Castellá,Hans-Christoph Diener,Hein Heidbuchel,Jeroen M.L. Hendriks,Gerhard Hindricks,Antonis S. Manolis,Jonas Oldgren,Bogdan A. Popescu,Ulrich Schotten,Bart P. Van Putte,Panagiotis Vardas,Stefan Agewall,John Camm,Gonzalo Barón Esquivias,Werner Budts,Scipione Carerj,Filip Casselman,Antonio Coca,Raffaele De Caterina,Spiridon Deftereos,Dobromir Dobrev,José M. Ferro,Gerasimos Filippatos,Donna Fitzsimons,Bulent Gorenek,Maxine Guenoun,Stefan H. Hohnloser,Philippe Kolh,Gregory Y.H. Lip,Athanasios J. Manolis,John J.V. McMurray,Piotr Ponikowski,Raphael Rosenhek,Frank Ruschitzka,Irina Savelieva,Sanjay Sharma,Piotr Suwalski,Juan Tamargo,Clare J Taylor,Isabelle C. Van Gelder,Adriaan A. Voors,Stephan Windecker,José Luis Zamorano,Katja Zeppenfeld +49 more