Clinical Strategies for Selecting Oral Anticoagulants in Patients with Atrial Fibrillation

Overview

Journal J Thromb Thrombolysis

Specialty Cardiology & Vascular Diseases

Date 2013 Jul 13

PMID 23846737

Citations 6

Authors

Sean D Pokorney

Matthew W Sherwood

Richard C Becker

Affiliations

Soon will be listed here.

Abstract

Atrial fibrillation is a common arrhythmia. One of the important aspects of the management of atrial fibrillation is stroke prevention. Warfarin has been the longstanding anticoagulant used for stroke prevention in patients with atrial fibrillation. There are now three novel oral anticoagulants, which have been studied in randomized controlled trials and subsequently approved by the Federal Drug Administration for stroke prevention in patients with atrial fibrillation. Special patient populations, including renal insufficiency, elderly, prior stroke, and extreme body weights, were represented to varying degrees in the clinical trials of the novel oral anticoagulants. Furthermore, there is variation in the pharmacokinetics and pharmacodynamics of each anticoagulant, which affect the patient populations differently. Patients and clinicians are faced with the task of selecting among the available anticoagulants, and this review is designed to be a tool for clinical decision-making.

Citing Articles

Impact of Polypharmacy and P-Glycoprotein- and CYP3A4-Modulating Drugs on Safety and Efficacy of Oral Anticoagulation Therapy in Patients with Atrial Fibrillation.

Harskamp R, Teichert M, Lucassen W, van Weert H, Lopes R Cardiovasc Drugs Ther. 2019; 33(5):615-623.

PMID: 31520256 PMC: 6904377. DOI: 10.1007/s10557-019-06907-8.

Accurate GFR in obesity-protocol for a systematic review.

Sriperumbuduri S, Dent R, Malcolm J, Hiremath S, Klein R, White C Syst Rev. 2019; 8(1):147.

PMID: 31228953 PMC: 6588895. DOI: 10.1186/s13643-019-1052-2.

Bleeding outcomes associated with rivaroxaban and dabigatran in patients treated for atrial fibrillation: a systematic review and meta-analysis.

Bundhun P, Soogund M, Teeluck A, Pursun M, Bhurtu A, Huang W BMC Cardiovasc Disord. 2017; 17(1):15.

PMID: 28056795 PMC: 5216587. DOI: 10.1186/s12872-016-0449-2.

Evaluation of Dabigatran- and Warfarin-Associated Hemorrhagic Events Using the FDA-Adverse Event Reporting System Database Stratified by Age.

Abe J, Umetsu R, Kato Y, Ueda N, Nakayama Y, Suzuki Y Int J Med Sci. 2015; 12(4):312-21.

PMID: 25897292 PMC: 4402434. DOI: 10.7150/ijms.10703.

Atrial fibrillation: a review of recent studies with a focus on those from the duke clinical research institute.

Rao M, Pokorney S, Granger C Scientifica (Cairo). 2014; 2014:901586.

PMID: 25215263 PMC: 4152955. DOI: 10.1155/2014/901586.

References

January C, Estes 3rd N, Page R, Ezekowitz M, Slotwiner D, Jackman W . 2011 ACCF/AHA/HRS focused update on the management of patients with atrial fibrillation (Updating the 2006 Guideline): a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2010; 57(2):223-42. DOI: 10.1016/j.jacc.2010.10.001. View

Corsonello A, Pedone C, Lattanzio F, Lucchetti M, Garasto S, Carbone C . Regimen complexity and medication nonadherence in elderly patients. Ther Clin Risk Manag. 2009; 5(1):209-16. PMC: 2697531. DOI: 10.2147/tcrm.s4870. View

Stangier J, Rathgen K, Stahle H, Gansser D, Roth W . The pharmacokinetics, pharmacodynamics and tolerability of dabigatran etexilate, a new oral direct thrombin inhibitor, in healthy male subjects. Br J Clin Pharmacol. 2007; 64(3):292-303. PMC: 2000643. DOI: 10.1111/j.1365-2125.2007.02899.x. View

Benjamin E, Levy D, Vaziri S, DAgostino R, Belanger A, Wolf P . Independent risk factors for atrial fibrillation in a population-based cohort. The Framingham Heart Study. JAMA. 1994; 271(11):840-4. View

Bertil Olsson S . Stroke prevention with the oral direct thrombin inhibitor ximelagatran compared with warfarin in patients with non-valvular atrial fibrillation (SPORTIF III): randomised controlled trial. Lancet. 2003; 362(9397):1691-8. DOI: 10.1016/s0140-6736(03)14841-6. View

Lip G, Huber K, Andreotti F, Arnesen H, Airaksinen J, Cuisset T . Antithrombotic management of atrial fibrillation patients presenting with acute coronary syndrome and/or undergoing coronary stenting: executive summary--a Consensus Document of the European Society of Cardiology Working Group on Thrombosis,.... Eur Heart J. 2010; 31(11):1311-8. DOI: 10.1093/eurheartj/ehq117. View

Miyasaka Y, Barnes M, Gersh B, Cha S, Bailey K, Abhayaratna W . Secular trends in incidence of atrial fibrillation in Olmsted County, Minnesota, 1980 to 2000, and implications on the projections for future prevalence. Circulation. 2006; 114(2):119-25. DOI: 10.1161/CIRCULATIONAHA.105.595140. View

Hankey G, Patel M, Stevens S, Becker R, Breithardt G, Carolei A . Rivaroxaban compared with warfarin in patients with atrial fibrillation and previous stroke or transient ischaemic attack: a subgroup analysis of ROCKET AF. Lancet Neurol. 2012; 11(4):315-22. DOI: 10.1016/S1474-4422(12)70042-X. View

Connolly S, Ezekowitz M, Yusuf S, Eikelboom J, Oldgren J, Parekh A . Dabigatran versus warfarin in patients with atrial fibrillation. N Engl J Med. 2009; 361(12):1139-51. DOI: 10.1056/NEJMoa0905561. View

10.

Miyasaka Y, Barnes M, Bailey K, Cha S, Gersh B, Seward J . Mortality trends in patients diagnosed with first atrial fibrillation: a 21-year community-based study. J Am Coll Cardiol. 2007; 49(9):986-92. DOI: 10.1016/j.jacc.2006.10.062. View

11.

Paikin J, Wright D, Crowther M, Mehta S, Eikelboom J . Triple antithrombotic therapy in patients with atrial fibrillation and coronary artery stents. Circulation. 2010; 121(18):2067-70. DOI: 10.1161/CIRCULATIONAHA.109.924944. View

12.

Kubitza D, Becka M, Zuehlsdorf M, Mueck W . Body weight has limited influence on the safety, tolerability, pharmacokinetics, or pharmacodynamics of rivaroxaban (BAY 59-7939) in healthy subjects. J Clin Pharmacol. 2007; 47(2):218-26. DOI: 10.1177/0091270006296058. View

13.

Novaro G, Asher C, Bhatt D, Moliterno D, Harrington R, Lincoff A . Meta-analysis comparing reported frequency of atrial fibrillation after acute coronary syndromes in Asians versus whites. Am J Cardiol. 2008; 101(4):506-9. DOI: 10.1016/j.amjcard.2007.09.098. View

14.

van Walraven C, Oake N, Wells P, Forster A . Burden of potentially avoidable anticoagulant-associated hemorrhagic and thromboembolic events in the elderly. Chest. 2007; 131(5):1508-15. DOI: 10.1378/chest.06-2628. View

15.

Mantha S, Ansell J . An indirect comparison of dabigatran, rivaroxaban and apixaban for atrial fibrillation. Thromb Haemost. 2012; 108(3):476-84. DOI: 10.1160/TH12-02-0093. View

16.

Price J, Hynes M, Labinaz M, Ruel M, Boodhwani M . Mechanical valve thrombosis with dabigatran. J Am Coll Cardiol. 2012; 60(17):1710-1. DOI: 10.1016/j.jacc.2012.06.039. View

17.

Lehr T, Haertter S, Liesenfeld K, Staab A, Clemens A, Reilly P . Dabigatran etexilate in atrial fibrillation patients with severe renal impairment: dose identification using pharmacokinetic modeling and simulation. J Clin Pharmacol. 2011; 52(9):1373-8. DOI: 10.1177/0091270011417716. View

18.

De Caterina R, Husted S, Wallentin L, Andreotti F, Arnesen H, Bachmann F . New oral anticoagulants in atrial fibrillation and acute coronary syndromes: ESC Working Group on Thrombosis-Task Force on Anticoagulants in Heart Disease position paper. J Am Coll Cardiol. 2012; 59(16):1413-25. DOI: 10.1016/j.jacc.2012.02.008. View

19.

Kubitza D, Becka M, Mueck W, Zuehlsdorf M . Safety, tolerability, pharmacodynamics, and pharmacokinetics of rivaroxaban--an oral, direct factor Xa inhibitor--are not affected by aspirin. J Clin Pharmacol. 2006; 46(9):981-90. DOI: 10.1177/0091270006292127. View

20.

MacLean S, Mulla S, Akl E, Jankowski M, Vandvik P, Ebrahim S . Patient values and preferences in decision making for antithrombotic therapy: a systematic review: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012; 141(2 Suppl):e1S-e23S. PMC: 3278050. DOI: 10.1378/chest.11-2290. View