Tag Archives: novel oral anticoagulants

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We believe that the new guideline2 will be a major advance in stroke prevention in AF. We would suggest that Professor Brady and colleagues, in their focus on non-vitamin K oral anticoagulants (NOACs), have overlooked the importance of a number of crucial aspects of the guideline. It represents a paradigm change in stroke management. The GDG were very keen to promote the concept that, whereas previously risk assessment was undertaken to define patients at high risk of stroke requiring anticoagulation, under the new guideline anticoagulation has become the norm for all but the lowest-risk patients. It represents a considerable simplification

When the NOACs (novel oral anticoagulants) were introduced over three years ago, they promised to revitalise the management of conditions such as atrial fibrillation (AF), venous thromboembolism (VTE) and thromboprophylaxis after major joint replacement surgery. Rivaroxaban is currently available in multiple indications, including (but not limited to): prevention of stroke and systemic embolism in adult patients with non-valvular AF, treatment of deep vein thrombosis (DVT) and pulmonary embolism (PE), and the prevention of recurrent DVT and PE in adults. For decades anticoagulant therapy in these conditions had relied on the vitamin K antagon

ESC guidelines and differences between NOACs Following the roll-out of the novel oral anticoagulants (NOACs), the European Society of Cardiology (ESC) published in 2012 a focused update of its guidelines for the management of atrial fibrillation (AF). Since the NOACs tested in clinical trials all showed at least non-inferiority when compared with vitamin K antagonists (VKAs), with a better safety profile, particularly with reduction in intracranial haemorrhage (ICH), the ESC 2012 guideline recommended NOACs as broadly preferable to VKAs in the vast majority of patients with non-valvular AF (NVAF).1 In 2013, the European Heart Rhythm Associati

Introduction Vitamin K antagonists (VKAs) reduce the risk of stroke in patients with atrial fibrillation (AF). For more than five decades, they were the only available treatment. Novel oral anticoagulants (NOACs) have recently been approved for the prevention of non-valvular AF-related stroke. Dose-adjusted VKA therapy and NOACs are highly effective in AF patients. However, dabigatran, rivaroxaban and apixaban are more convenient, while at least equally effective and with a comparable safety profile (regarding bleeding complications) for stroke prevention compared with VKAs.1-3 Recent guidelines prefer treatment with NOACs over VKAs for most

*citation from Havelock Ellis ‘Impressions and Comments’ Introduction Rivaroxaban is an oral direct factor Xa inhibitor belonging to the novel oral anticoagulants (NOACs) class. Concerning efficacy and tolerability, it has been reported to be more effective than enoxaparin in preventing venous thromboembolism in patients undergoing orthopaedic surgery,1,2 and was non-inferior to enoxaparin followed by warfarin in a study involving patients with established venous thrombosis.3 Its good bioavailability, rapid-action and a half-life of 5–13 h,4 associated with a highly reproducible anticoagulant activity and the same rate of bleeding compl

Summary Oral anticoagulation has been restricted to vitamin K antagonists (VKAs) for more than 50 years. Starting in the last decade of the past century, central coagulation factors such as thrombin and factor Xa were explored as potential targets for the development of novel oral anticoagulants (NOACs). This led to the successful development and approval of a novel class of direct oral anticoagulants targeting factor Xa. Rivaroxaban was the first of the novel class of agents named ‘xabans’ that are direct oral factor Xa inhibitors. Since its initial approval for thromboembolic prophylaxis after hip and knee surgery in 2008, rivaroxaban a

Background The novel oral anticoagulant (NOAC) agents (dabigatran, rivaroxaban, apixaban) have had a disproportionally poor uptake since their respective launches and National Institute for Health and Care Excellence (NICE) Technology Appraisal in the UK between 2012 and 2013 for their use in stroke prevention in patients with non-valvular atrial fibrillation (NVAF), when compared with our European counterparts; particularly Germany, Holland and France. In the original NICE economic analyses for the NOACs there was a calculated uptake of approximately 20% in the first year,1 the figure currently runs at <8% with many area’s significantly

Stroke risk assessment in AF New insights on stroke risk assessment were provided by Dr Ami Banerjee (University of Birmingham), in a session supported by the Atrial Fibrillation Association. Table 1. CHADS2 score The CHADS2 risk stratification scoring system (table 1) is currently the indicator for the Quality and Outcomes (QoF) framework used to determine whether an atrial fibrillation (AF) patient warrants anticoagulation. It may underestimate risk and those with a score of zero may actually be at substantial stroke risk. He also pointed out that the system has inherent disadvantages. It does not include many of the risk factors for stroke