Tag Archives: NOACs

Effective anticoagulation improves outcomes in patients with AF or VTE.4-7 Non-vitamin K antagonist oral anticoagulants (NOACs) have provided an alternative to warfarin for prevention of stroke or recurrent VTE in these patients in recent years. Compared with warfarin, NOACs have more predictable pharmacokinetics and pharmacodynamics, do not require monitoring of the international normalised ratio (INR), and have a wider therapeutic window that enables prescription at fixed daily doses over an extended period.8 Edoxaban, an inhibitor of Factor Xa is a member of the NOAC class. The accompanying articles summarise latest findings on the effect

Introduction Figure 1. Open irrigated catheter, with pores for flow of heparinised saline seen on the tip Susceptibility to stroke is increased around the time of catheter ablation; with ablation of atrial fibrillation (AF) being the most prevalent electrophysiological procedure and, thus, the most studied. Pre-ablation of AF, there is an increased risk of thrombus formation in the left atrial appendage; with potential for embolisation during restoration of normal sinus rhythm.1 During ablation, the risk of thromboembolism is accounted for by endothelial injury, hypercoagulability due to contact of blood with foreign surfaces and altered blo

New practical NOACs guide A new version of EHRA Practical Guide on the use of non-vitamin K antagonist oral anticoagulants (NOACs) in patients with atrial fibrillation (AF) was launched at the congress. ESC guidelines state that NOACs should be preferred over vitamin K antagonists, such as warfarin, for stroke prevention in AF patients, except those with a mechanical heart valve or rheumatic mitral valve stenosis, and their use in clinical practice is increasing. The guide gives concrete, practical advice on how to use NOACs in specific clinical situations. The guide is published in European Heart Journal (doi: 10.1093/eurheartj/ehy136). Anti

Drug therapies include anticoagulants to reduce the risk of stroke and anti-arrhythmics to restore/maintain the normal heart rhythm or slow the heart rate in patients who remain in AF. Non-pharmacological management options include electrical cardioversion, which may be used to ‘shock’ the heart back to its normal rhythm. The high risk of stroke associated with electrical cardioversion can be reduced by oral anticoagulation. Although effective in reducing the risk of thromboembolism, the limitations of warfarin present considerable challenges for its use in clinical practice. The challenges of maintaining warfarin within an appropriate th

Understanding the mechanisms of AF lies at the heart of its treatment. AF occurs when structural and/or electrophysiological abnormalities alter atrial tissue to promote abnormal impulse formation and/or propagation (figure 1).3 Multiple clinical risk factors, electrocardiographic/echocardiographic features and biochemical markers are associated with an increased risk of AF (table 1), and, AF can be described in terms of the duration of episodes using a simplified scheme (table 2).3 Figure 1. Mechanisms of atrial fibrillation Table 1. Risk factors3 The aim of treatment is to prevent stroke and alleviate symptoms.4 Drug therapies include antic

New AF guidelines The first collaborative European Society of Cardiology (ESC) and European Association for Cardio-Thoracic Surgery (EACTS) Guidelines on Atrial Fibrillation (AF) were published at the start of the congress.1 These multidisciplinary guidelines focus on early detection of asymptomatic AF, recommending both opportunistic and targeted screening for all patients aged ≥65 years, or with stroke or transient ischaemic attack (TIA). In addition, the guidelines deal with long-term challenges in the management of AF patients, with recommendations on what to do when patients develop complications on anticoagulation, re-initiation of an

Approval for new heart failure treatment A breakthrough drug for the treatment of chronic heart failure is now available in the UK.  The new drug sacubitril/valsartan (Entresto®, Novartis) has been approved for the treatment of adults with symptomatic heart failure with reduced left ventricular ejection fraction (HFREF). Sacubitril/valsartan – the first drug in the angiotensin receptor neprilysin inhibitor (ARNI) class of drugs – was found to be superior to an evidence-based dose of the angiotensin-converting enzyme (ACE) inhibitor, enalapril, in the PARADIGM-HF study, the largest heart failure study conducted to date. PARADIGM-HF (Pros

Chair of the writing group Professor Christian Sticherling (Universitätsspital Basel, Switzerland) said: “Traditionally we interrupted anticoagulation during device implantation and restarted it afterwards. And we bridged with heparin around the time of the operation. The new recommendation is to continue to give the VKA and perform the operation without any bridging. That shows the lowest rate of perioperative bleeding.” He added: “Also new is the recommendation not to interrupt VKAs during ablation and particularly during pulmonary vein isolation which is the most common type of ablation nowadays.” The paper, produced by the EHRA,

Dear Sirs, We read with interest Diana Gorog’s recent article on the uptake of non-vitamin K oral anticoagulants (NOACS) in the UK.1 She drew attention to the slow uptake of these agents in the UK as opposed to many countries in Europe, and certainly the USA, and to the role that local medicines management committees (MMCs) may play in this. While the National Institute for Health and Care Excellence (NICE) guidance regarding all three NOACs available in the UK (apixaban, dabigatran and rivaroxaban) is that they should be available as an option for stroke prevention in non-valvular atrial fibrillation (AF), many MMCs in the UK have sought t

Obstructive sleep apnoea and neurovascular disease The association between obstructive sleep apnoea (OSA) and neurovascular disease was discussed by Dr David Hargroves (British Association of Stroke Physicians Education and Training Chair) and colleagues from East Kent during the training day at the conference. Dr Hargroves presented previously published data which shows that OSA is not uncommon: 24% of men and 9% of women in the general population may have OSA, 3−4% with clinically ‘obvious’ sequelae, and 60% of older and obese people may have OSA.1 Clinicians treating patients with neurological presentations should have a high index o