Efficacy Of New Oral Anticoagulants Research Articles

Efficacy of New Oral Anticoagulants Compared to Warfarin in Different Age Groups of Patients with Atrial Fibrillation: A Literature Review

Efficacy of New Oral Anticoagulants Compared to Warfarin in Different Age Groups of Patients with Atrial Fibrillation: A Literature Review

Safety and efficacy of new oral anticoagulants compared to those of warfarin in AF patients with cancer: a meta-analysis of randomized clinical trials and observational studies.

Data on the efficacy and safety of nonvitamin K antagonist oral anticoagulants (NOACs) in atrial fibrillation (AF) patients with cancer are limited. Therefore, we conducted a meta-analysis to compare the efficacy and safety between NOACs and warfarin in this population. A comprehensive search of the PubMed, Embase, and Cochrane databases for articles published through July 2020 was performed. An evaluation of each study was conducted, and data were extracted. Pooled odds ratio (OR) estimates and 95% CIs were calculated. Eight studies (3 randomized controlled trials (RCTs) and 5 retrospective cohort studies) involving a total of 24,665 patients were included. Among the RCTs, there were no significant differences in the rates of stroke or systemic embolism (OR=0.69; 95% CI, 0.45-1.06; P=0.09), venous thromboembolism (OR=0.91; 95% CI, 0.33-2.52; P=0.86), myocardial infarction (OR=0.74; 95% CI, 0.44-1.23; P=0.24), major bleeding (OR=0.81; 95% CI, 0.61-1.06; P=0.12), or major or nonmajor clinically relevant bleeding (OR= 0.98; 95% CI, 0.82-1.19; P=0.86) between the NOAC and warfarin groups. Among the observational studies, patients who used NOACs had a significantly lower risk than those who used warfarin. The prevalence rates of ischemic stroke (OR=0.51; 95% CI, 0.28-0.92; P=0.02), VTE (OR=0.50; 95% CI, 0.41-0.60; P<0.00001), major bleeding (OR=0.28; 95% CI, 0.14-0.55; P=0.0002), and intracranial or gastrointestinal bleeding (OR=0.59; 95% CI, 0.37-0.92; P=0.02) were significantly reduced in the NOAC group. Our meta-analysis confirms that NOACs are as safe and effective as warfarin and can be applied in the real world; this data can serve as a reference for clinical doctors for formulating treatment strategies.

New Oral Anticoagulants in Nonvalvular Atrial Fibrillation.

The choice of an oral anticoagulant (OAC) for patients with nonvalvular atrial fibrillation (NVAF) is a major and complex clinical decision taking into account the individual risk-benefit ratio and bearing in mind the chronicity of therapy. This review focuses on the safety and efficacy of new oral anticoagulants (NOACs) compared with conventional vitamin K antagonists (VKA) in patients with NVAF. Current data suggest that NOACs are at least as effective and safe as VKAs for most NVAF subjects. The NOACs do not mandate dietary restrictions and regular pharmacodynamic monitoring, and they seem to have lesser incidence of intracranial or fatal bleeding when compared with VKAs. However, both dabigatran 150 twice daily and rivaroxaban have a slightly higher incidence of gastrointestinal bleeding when compared with VKAs. The article will delineate the current knowledge as well as scientific gaps related to the choice and dosage of anticoagulation regimens for various NVAF subsets and will address certain common clinical scenarios requiring special considerations. The article also addresses the shortcomings of NOACs: lack of therapeutic pharmacokinetic and pharmacodynamic targets, absence of tools to assess compliance and efficacy, rigid and limited dosage options, and absence of effective and inexpensive reversal agents.

Safety and Efficacy of New Oral Anticoagulants in Patients with Atrial Fibrillation: A Literature Review

Background: TraditionallyVitamin K antagonists (VKAs), such as warfarin, have been used to reduce the risks of stroke and systemic embolism in patients with atrial fibrillation (AF). However, they are associated with increased risk of haemorrhage. Thus, there is a need for new oral anticoagulant agents that are effective, safe, and convenient to use. Recent, observational and randomized controlled clinical trials, have examined the long-term use and efficacy of new oral anticoagulants. However, their results pertaining to important secondary efi¬cacy end points as well as safety outcomes were inconclusive. Aim: We, therefore, performed a systematic review to examine the long-term efi¬cacy and safety of the new oral anticoagulants namely; dabigatran, rivaroxaban and apixaban in patients with AF. Methods: In total 286 abstracts have been screened and 21 articles have been selected and considered as relevant for this epidemiological review. The primary efi¬cacy endpoint was the incidence of stroke or systemic embolism. The primary safety endpoint was the incidence of major bleeding. Results: We observed that dabigatran and rivaroxaban are more efi¬cacious than warfarin for the prevention of stroke, death and systemic embolism. Also, they decrease the risk for intracranial bleeding and appear to have a favorable safety proi¬le, making them promising alternatives to warfarin. Conclusions: Overall, our results support the use of the new oral anticoagulants as alternatives to warfarin for long-term anticoagulation therapy in patients with AF.

Meta-analysis on efficacy and safety of new oral anticoagulants for venous thromboembolism prophylaxis in elderly elective postarthroplasty patients.

The risk of venous thromboembolism (VTE) increases with age. New oral anticoagulants (NOACs) have been increasingly studied for VTE prophylaxis in patients with elective postarthroplasty. Although the elderly population accounts for a significant proportion of patients requiring VTE prophylaxis, safety and efficacy of NOACs in this subgroup for VTE prophylaxis has not been well studied. Relevant studies were identified through electronic literature searches of MEDLINE, EMBASE, Cochrane Library, and ClinicalTrials.gov (from inception to 12 August 2014). Phase III randomized controlled trials that compared NOACs against low-molecular-weight heparin (LMWH) in the prevention of VTE prophylaxis in patients with elective postarthroplasty were included. We defined our elderly population as adults of at least 75 years and assessed the reported safety and efficacy outcomes with NOACs in this population. Study-specific odds ratios (ORs) were calculated and between-study heterogeneity was assessed using the I statistic. In nine trials involving 29 403 patients, the risk of VTE or VTE-related deaths in elderly patients with elective postarthroplasty was similar with NOACs compared with LMWH (OR 0.62, 95% confidence interval 0.30-1.26; P = 0.18; I = 44%) but bleeding risk was significantly lower (OR 0.71, 95% confidence interval 0.53-0.94; P = 0.02; I = 0%). Analysis of individual NOACs showed superior efficacy but similar safety for apixaban when compared with LMWH. Efficacy and safety profiles of rivaroxaban and dabigatran were similar to LMWH. In elderly patients with elective postarthroplasty, NOACs have similar efficacy but superior safety when compared with enoxaparin for VTE prophylaxis.

New Oral Anticoagulants in the Treatment of Heparin- Induced Thrombocytopenia

BackgroundHeparin induced thrombocytopenia (HIT) is a potentially catastrophic syndrome with a high incidence of vascular thrombosis. There are little data on the efficacy of new oral anticoagulants (NOAC) in this setting. This study reports on the outcome of patients with HIT, treated with NOAC. Materials and MethodsWe retrospectively identified 22 patients with HIT who were treated by our group with a combination of NOAC and a short course of argatroban. These patients were evaluated in a prospective fashion for development of outcomes at a mean follow up of 19±3months. ResultsThere were a total of 5 deep and 2 superficial vein thromboses diagnosed at index hospitalization. No patient developed arterial thrombosis. All patients tolerated NOAC and their platelet count normalized before discharge. At 19months of follow-up, 6 patients had died of non-thrombotic causes. There was no bleeding, limb loss or recurrent venous thromboembolism in any patient. ConclusionsIn patients with HIT, a short course of parenteral treatment with argatroban followed by administration of a NOAC is highly safe and effective in prevention of thrombosis and normalization of platelet count. Development of HIT however, portends a poor prognosis independent of vascular thrombosis.

PCV18 - Comparative Efficacy Of New Oral Anticoagulants For Stroke Prevention In Atrial Fibrillation Among Patients With Prior Stroke Or Systemic Embolism

Patients with atrial fibrillation (AF) and a previous stroke or transient ischaemic attack (TIA) have a high risk of stroke and may have a different baseline risk than patients without previous stroke or TIA, which may act as a treatment effect modifier. Therefore, the comparative efficacy of new oral anticoagulants (NOACs) in terms of stroke or systemic embolism (SE) was assessed for the subgroup of patients with a previous stroke or TIA. A Bayesian network meta-analysis (NMA) was performed for patients with previous stroke or TIA from three pivotal randomized controlled trials: ARISTOTLE, RE-LY, and ROCKET-AF, which compared apixaban, dabigatran, and rivaroxaban to warfarin, respectively. Parametric survival functions were used to model the hazard ratios (HR) over time for the compared interventions, and the difference in the shape and scale parameters of these functions was synthesized and indirectly compared. Results were compared to an analysis of constant HRs as well as to previous NMAs for this subgroup. The time-varying HRs for the treatments versus warfarin suggest that each NOAC is at least as efficacious as warfarin with respect to stroke and SE. The HR for dabigatran 150mg was fairly constant over time (range: 0.80-0.68). The HR for dabigatran 110mg decreased slightly over time (range: 1.82-0.40), whereas the HRs increased slightly over time for rivaroxaban (range: 0.61-1.34) and apixaban (range: 0.62-0.94). Based on the NMA of stroke or SE among patients with AF and a prior stroke or TIA, dabigatran 150mg and apixaban are expected to be comparable to warfarin; dabigatran 110mg is expected to be comparable to warfarin for the first 16 months and more efficacious up until 30 months; rivaroxaban is expected to more efficacious than warfarin for the first 4 months, and comparable to warfarin thereafter.

COMPARATIVE EFFICACY AND SAFETY OF NEW ORAL ANTICOAGULANTS VERSUS WARFARIN FOR LONG-TERM TREATMENT OF VENOUS THROMBOEMBOLISM: A META-ANALYSIS

Whether, new oral anticoagulants (NOACs) are alternative to warfarin for extended treatment of venous thromboembolism (VTE) is not clear. We performed a meta-analysis of all randomized controlled trials (RCTs) to assess the safety and efficacy of NOACs for long-term treatment of VTE. We searched

Consistency of safety and efficacy of new oral anticoagulants across subgroups of patients with atrial fibrillation.

AimsThe well-known limitations of vitamin K antagonists (VKA) led to development of new oral anticoagulants (NOAC) in non-valvular atrial fibrillation (NVAF). The aim of this meta-analysis was to determine the consistency of treatment effects of NOAC irrespective of age, comorbidities, or prior VKA exposure.Methods and ResultsAll randomized, controlled phase III trials comparing NOAC to VKA up to October 2012 were eligible provided their results (stroke/systemic embolism (SSE) and major bleeding (MB)) were reported according to age (≤ or >75 years), renal function, CHADS2 score, presence of diabetes mellitus or heart failure, prior VKA use or previous cerebrovascular events. Interactions were considered significant at p <0.05. Three studies (50,578 patients) were included, respectively evaluating apixaban, rivaroxaban, and dabigatran versus warfarin. A trend towards interaction with heart failure (p = 0.08) was observed with respect to SSE reduction, this being greater in patients not presenting heart failure (RR = 0.76 [0.67–0.86]) than in those with heart failure (RR = 0.90 [0.78–1.04]); Significant interaction (p = 0.01) with CHADS2 score was observed, NOAC achieving a greater reduction in bleeding risk in patients with a score of 0–1 (RR 0.67 CI 0.57–0.79) than in those with a score ≥2 (RR 0.85 CI 0.74–0.98). Comparison of MB in patients with (RR 0.97 CI 0.79–1.18) and without (RR 0.76 CI 0.65–0.88) diabetes mellitus showed a similar trend (p = 0.06). No other interactions were found. All subgroups derived benefit from NOA in terms of SSE or MB reduction.ConclusionsNOAC appeared to be more effective and safer than VKA in reducing SSE or MB irrespective of patient comorbidities. Thromboembolism risk, evaluated by CHADS2 score and, to a lesser extent, diabetes mellitus modified the treatment effects of NOAC without complete loss of benefit with respect to MB reduction.

Efficacy of new oral anticoagulants in patients with atrial fibrillation previously treated with warfarin: A meta-analysis of randomized controlled trials

Efficacy of new oral anticoagulants in patients with atrial fibrillation previously treated with warfarin: A meta-analysis of randomized controlled trials