Real-World Safety of Anticoagulants (original) (raw)

A new gap in the novel anticoagulants’ era

Blood Coagulation & Fibrinolysis, 2015

After long years of using warfarin for atrial fibrillation, new oral anticoagulants (NOACs) became available for decreasing the risk of ischemic stroke. Our aim was to observe the physicians prescribing patterns of NOACs. This prospective observational study included patients using NOACs applying consecutively to our outpatient clinic. Physical examination was performed, and patient history, electrocardiogram, transthoracic echocardiography, and biochemical results were collected. Bleeding and ischemic stroke risk scores (HAS-BLED and CHA 2 DS 2-VASc scores) were calculated. We evaluated patients' characteristics, risk factors, concomitant drug usage, and physicians' choices. The study consisted of 174 patients using NOACs (dabigatran 113 patients, rivaroxaban 61 patients), with a mean age of 70.7 W 8.8 years. The mean HAS-BLED score was 1.74 W 0.9 and the mean CHA 2 DS 2-VASc score was 3.7 W 1.2. Fifty-three (30.4%) patients were prescribed lowdose NOAC according to the optimal dose, and 12 (6.8%) patients were prescribed high-dose NOAC according to the optimal dose. We compared optimal dose and undertreatment groups to find out if there was any predicting factor for physicians to use low dose of NOACs, but there was no significant difference between the two groups for age, sex, concomitant chronic disease, and CHA 2 DS 2-VASc and HAS-BLED scores. NOACs were prescribed to patients mostly with high CHA 2 DS 2-VASc score and low HAS-BLED score. Low-dose NOAC usage according to the optimal dose was frequent. Frequent coagulation monitoring and drug incompliance are big deficiencies at atrial fibrillation in use of warfarin. NOACs overcome these difficulties; however, physicians' hesitation to use NOACs with the optimal dosage may be another limitation in real-world practice. Blood Coagul Fibrinolysis

Evaluation of Medication Management Safety in Patients Using Oral Anticoagulants

Journal of Anatolia Nursing and Health Sciences, 2016

This study is planned as a descriptive study in order to identify the safe medication for the individuals who are given oral anti-coagulator treatment. Methods: The population of this research involves the patients who take OAC under observation in the outpatient departments and cardiology policlinics, inpatients in cardiology and coronary intensive care of a university hospital between February 2011-February 2012. The sample involves 145 patients having the criteria who had an informed consent after being explained the aim of the research. The data is collected by a questionnaire of questions on socio-demographic features, the treatment they take, and their knowledge, attitudes towards OAC The analysis of data is performed on the computer with SPSS 15 package. Results: As a result of this research, the mean age of the individuals is seen as 53.14±13.83 years. It is also found out that about 64.1% of the patients use 5 mg./day of OAC medication, about 40 % have had no training about the medication, about 75.9 % have experienced side effects of bleeding. The mean score of knowledge and attitude of the patients having OAC medication is 3.552.01(low) ve 7.422.03 (high). It is detected that there is a significant relationship between the mean score of knowledge and age, sex, education level, training and side effect experience (p<0.05). The mean score of attitude is detected to have a significant relationship only with having a medicine management training (p<0.05). Knowledge and attitude mean scores are found out to have a weak but positive significant relationship (p<0.05). Conclusions: It is determined that safe drug management of the patients who take oral anti-coagulator treatment is inadequate and that they require guidance, counselling and training on this subject.

Pharmacology of new oral anticoagulants: mechanism of action, pharmacokinetics, pharmacodynamics

Italian Journal of Medicine, 2013

Due to their mechanism of action, the new oral anticoagulants are named direct oral anticoagulants (DOACs). Dabigatran is a selective, competitive, direct inhibitor of thrombin (Factor IIa) while rivaroxaban, apixaban and edoxaban act by directly inhibiting the activated Factor X (FXa) in a selective and competitive manner. DOACs have a relatively short half-life and almost immediate anticoagulant activity, and rapidly reach the plasma peak concentration. Therefore, they do not need a phase of overlapping with parenteral anticoagulants. After their withdrawal, their removal is sufficiently rapid, although influenced by renal function. Dabigatran is the only DOACs to be administered as a pro-drug and becomes active after drug metabolization. The route of elimination of dabigatran is primarily renal, whereas FXa inhibitors are mainly eliminated by the biliary-fecal route. The drug interactions of DOACs are mainly limited to drugs that act on P-glycoprotein for dabigatran and on P-glycoprotein and/or cytochrome P3A4 for anti-Xa. DOACs have no interactions with food. Given their linear pharmacodynamics, with a predictable dose/response relationship and anticoagulant effect, DOACs are administered at a fixed dose and do not require routine laboratory monitoring.

Pharmacological Aspects of Newer Drugs Used in Anticoagulant Therapy

Journal of Evolution of medical and Dental Sciences, 2013

1 Parenteral low molecular weight heparins like enoxaparin, dalteparin, tinzaparin, synthetic heparin derivatives fondaparinux, direct thrombin inhibitors like lepirudin, bivalirudin, argatroban, oral anticoagulants like Dabigatran, Rivaroxiban are newer anticoagulants. The emergence of new oral anticoagulants has the advantage over old drugs is their predictable pharmacokinetics, pharmacodynamics properties, adverse effects clinically less relevant and their different mechanism of action. Clinically these new anticoagulant drugs are preferred for prophylaxis of patients undergoing hip or knee surgery to prevent deep vein thrombosis, after the replacement of heart valve, open-heart surgery to prevent clot formation and for therapy of pulmonary embolism (synthetic derivatives). Also as an alternative in patients diagnosed with heparin induced thrombocytopenia who require anticoagulation 2 .

The target-specific oral anticoagulants: practical considerations

Hematology / the Education Program of the American Society of Hematology. American Society of Hematology. Education Program, 2014

More than 4 years have passed since the first approval of a target-specific oral anticoagulant (TSOAC) in the United States, and the number of clinicians who have prescribed (or considered prescribing) one or more of these medications is increasing. Although these agents may, in properly selected patients, offer advantages over more traditional therapies, their lack of familiarity can be intimidating. Clinicians who are prescribing the TSOACs face a number of management questions not definitively answered by the registration trials. This chapter reviews some of these situations, including updated information on the periprocedural management of TSOACs and the latest evidence about how to best measure TSOAC effect. The lack of an antidote and other considerations that may be relevant when deciding between newer and more traditional anticoagulant medications are also discussed.