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Renal function, P-gp-affecting drugs and new anticoagulants for stroke prevention
New oral anticoagulants (NOAs), like the thrombin-inhibitor dabigatran etexilate or the factor Xa-inhibitor rivaroxaban showed similar efficacy as the vitamin-K-antagonist (VKA) warfarin for stroke prevention in patients with atrial fibrillation (AF) . One of the advantages of the NOAs, compared with VKAs, should be the lack of the necessity for laboratory monitoring and its lower rate of drug- and food interactions. The serum concentration of NOAs, however, is influenced by renal function. Furthermore, NOA-absorption is dependent on the intestinal P-glycoprotein (P-gp)-system, and P-gp activity is influenced by several dr...
Source: International Journal of Cardiology - February 11, 2013 Category: Cardiology Authors: Florian Höllerl, Claudia Stöllberger, Josef Finsterer Tags: Letters to the Editor Source Type: research

Relative efficacy and safety of non-Vitamin K oral anticoagulants for non-valvular atrial fibrillation: Network meta-analysis comparing apixaban, dabigatran, rivaroxaban and edoxaban in three patient subgroups
Stroke is the most serious clinical consequence of atrial fibrillation, which is the most common cardiac arrhythmia. Non-vitamin K antagonist oral anticoagulants (NOACs) have emerged as efficacious, safe and convenient stroke prevention agents. This updated network meta-analysis focused on the relative efficacy and safety of apixaban compared with dabigatran, rivaroxaban and edoxaban for stroke prevention in (i) patients with CHADS2 score ≥2, (ii) secondary stroke prevention, and (iii) patients with high quality anticoagulation control with warfarin.
Source: International Journal of Cardiology - November 17, 2015 Category: Cardiology Authors: Gregory Y.H. Lip, Stephen A. Mitchell, Xianchen Liu, Larry Z. Liu, Hemant Phatak, Sumesh Kachroo, Sarah Batson Source Type: research

There is a need for independent studies about new oral anticoagulants in atrial fibrillation patients
Dabigatran, rivaroxaban, and apixaban are new oral anticoagulants (NOAC) which have been investigated in patients with atrial fibrillation (AF) for primary and secondary prevention of stroke and thromboembolism . In RELY, ROCKET-AF and ARISTOTLE, NOAC had a similar efficacy and safety profile like vitamin-K-antagonists (VKA). Based on these results, NOAC are recommended by national and international societies as an alternative to VKA or even the first choice drug for the prevention of stroke or embolism in AF-patients.
Source: International Journal of Cardiology - January 21, 2014 Category: Cardiology Authors: Claudia Stöllberger, Birke Schneider, Josef Finsterer Tags: Online Letters to the Editor Source Type: research

Antiplatelet Properties of Oral Anticoagulants
Until recently, vitamin K antagonists (VKA) were the only oral anticoagulant drugs used in clinical practice for stroke or systemic embolism prevention in patients with non-valvular atrial fibrillation (AF). New oral anticoagulant drugs such as dabigatran etexilate and rivaroxaban have been developed and are currently available as an alternative in this indication. Both drugs were demonstrated to be non-inferior to warfarin for the prevention of stroke or systemic embolism in patients with non-valvular AF in the RE-LY and ROCKET trials [1,2].
Source: International Journal of Cardiology - December 23, 2014 Category: Cardiology Authors: Corinne Frère, Marc Laine, Franck Paganelli, Françoise Dignat-George, Laurent Bonello Tags: Letter to the Editor Source Type: research

Assessing the impact of dabigatran and warfarin on health-related quality of life: Results from an RE-LY sub-study
Conclusions: Over the course of one year, all anticoagulated patients without outcome events (e.g. strokes or major bleedings) had stable HRQoL. Scores between dabigatran and warfarin were comparable, which was unexpected given the known complexities of warfarin treatment.
Source: International Journal of Cardiology - May 10, 2013 Category: Cardiology Authors: B.U. Monz, S.J. Connolly, M. Korhonen, H. Noack, J. Pooley Tags: Original Articles Source Type: research

Efficacy of new oral anticoagulants in patients with atrial fibrillation previously treated with warfarin: A meta-analysis of randomized controlled trials
Vitamin K antagonists (VKAs), together with newer oral anticoagulants (NOACs) such as dabigatran, rivaroxaban, or apixaban, reduce the risk of stroke in patients with atrial fibrillation (AF). However, patients with no prior exposure to anticoagulation (i.e., VKA naive) may be at higher risk for adverse outcomes (thromboembolic events and/or bleeding) than patients who are VKA experienced. When adjusted-dose VKA (INR 2–3) cannot be used in a patient with AF where an oral anticoagulant (OAC) is recommended, due to difficulties in keeping INR within therapeutic range of 2 to 3, experiencing side effects of VKAs, or inabili...
Source: International Journal of Cardiology - March 13, 2014 Category: Cardiology Authors: Laurent Fauchier, Nicolas Clementy, Christophe Saint-Etienne, Edouard Simeon, Denis Angoulvant, Anne Bernard-Brunet Tags: Letters to the Editor Source Type: research

Prothrombotic risk of vitamin K antagonists during the first days of treatment: One more reason to use new oral anticoagulants
In the controlled clinical trials ROCKET AF and ARISTOTLE, which included patients with nonvalvular atrial fibrillation (AF), introduction of warfarin was associated with an excess of ischemic strokes during the first 30days after randomization in vitamin K antagonist (VKA)-naive patients compared with warfarin-experienced patients (4.40/100 patient-years versus 2.86/100 patient-years in ROCKET AF and 5.41/100 patient-years versus 1.42/100 patient-years in ARISTOTLE) [1]. A similar observation was made in the RE-LY trial, in which the risk of ischemic stroke was 0.26% for warfarin versus 0.12% for dabigatran (odds ratio 2....
Source: International Journal of Cardiology - March 19, 2015 Category: Cardiology Authors: Sébastien Gaertner, Elena-Mihaela Cordeanu, Corina Mirea, Dominique Stephan Tags: Letter to the editor Source Type: research

Bleeding risk in patients treated with dabigatran or vitamin K antagonist for atrial fibrillation: A meta analysis of adjusted analysis in routine practice settings
Large randomized controlled trials have found that in non-valvular atrial fibrillation (AF), non-vitamin K antagonist oral anticoagulants (NOACs) had a favorable risk–benefit profile, with significant reductions in stroke, mortality and intracranial hemorrhage, but possibly increased gastrointestinal bleeding [1]. After the approval of dabigatran, many agencies in different countries received reports of severe dabigatran related bleeding reports through their adverse event reporting system. Concurrently, several case reports of dabigatran induced bleeding were published in medical journals and discussed in the mainstream media.
Source: International Journal of Cardiology - January 6, 2016 Category: Cardiology Authors: Walid Darwiche, Theodora Bejan-Angoulvant, François Dievart, Dominique Babuty, Denis Angoulvant, Laurent Fauchier Tags: Correspondence Source Type: research

Dabigatran in clinical practice: Contemporary overview of the evidence
Oral anticoagulation is the cornerstone of stroke prevention in non-valvular atrial fibrillation (AF) and management of venous thromboembolism (VTE), resulting in a reduction in thrombotic complications and mortality. Benefit of vitamin K antagonists (VKAs) in such patients has been unambiguously confirmed, but VKA use is complicated by need for regular monitoring of the international normalized ratio and multiple drug and food interactions.Dabigatran is an oral direct thrombin inhibitor that can be used with fixed doses, without the need for routine anticoagulation laboratory monitoring and the advantage of few drug or diet interactions.
Source: International Journal of Cardiology - June 22, 2016 Category: Cardiology Authors: Walter Ageno, John Eikelboom, Gregory Y.H. Lip Source Type: research

Reduced dose and reduced exposure to non-vitamin K-antagonist oral anticoagulants: Some considerations on this relationship
For the prevention of stroke and/or systemic embolism (SSE) in non-valvular atrial fibrillation (NVAF), the four available non-vitamin K-antagonist oral anticoagulants (NOACs) are each marketed in a higher and a lower dose: 150 and 110mg for dabigatran, 20 and 15mg for rivaroxaban, 5 and 2.5mg for apixaban and 60 and 30mg for edoxaban. The lower dose is commonly used with the aim to reduce the patient's exposure to the drug (and its anticoagulant effect), thereby reducing the risk of bleeding. This however, may not always be true, depending on the NOAC used and the characteristics of the patients to whom the NOAC is given.
Source: International Journal of Cardiology - August 10, 2016 Category: Cardiology Authors: Andrea Rubboli, Freek W.A. Verheugt Tags: Correspondence Source Type: research