Anna Plitt1, Sameer Bansilal2. 1. Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY. 2. Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY.
Abstract
The nonvitamin K antagonist oral anticoagulants (NOACs) dabigatran, rivaroxaban, apixaban, and edoxaban are used for the reduction of the risk of stroke or systemic embolism (SEE) in patients with nonvalvular atrial fibrillation (NVAF). The purpose of this review is to highlight the safety and efficacy results of the pivotal NOAC clinical trials for use in NVAF, discuss some of the unique management challenges in the use of NOACs in special populations, summarize data on emerging and novel indications, and address potential future directions. METHODS: A literature search was conducted and to identify relevant clinical trials and studies regarding the use of NOACs for the prevention of stroke or SEE in patients with atrial fibrillation. RESULTS: Relative to warfarin, NOACs are as effective or superior in the prevention of stroke or SEE, and are associated with similar or lower rates of major bleeding and significantly decreased rates of intracranial bleeding, but may be associated with a slightly increased risk of gastrointestinal bleeding in patients with AF. The NOACs are not indicated for use and have not been widely tested in AF patients with other cardiovascular conditions. Additional ongoing and planned clinical trials will provide additional information regarding the use of NOACs in these patients. In situations requiring rapid reversal of anticoagulation, the availability of specific antidotes will improve safety and facilitate NOAC use. CONCLUSIONS: Use of NOACs in clinical practice requires consideration of patient characteristics as well as potentially required procedures.
The nonvitamin K antagonist oral anticoagulants (NOACs) dabigatran, rivaroxaban, apixaban, and edoxaban are used for the reduction of the risk of stroke or systemic embolism (SEE) in patients with nonvalvular atrial fibrillation (NVAF). The purpose of this review is to highlight the safety and efficacy results of the pivotal NOAC clinical trials for use in NVAF, discuss some of the unique management challenges in the use of NOACs in special populations, summarize data on emerging and novel indications, and address potential future directions. METHODS: A literature search was conducted and to identify relevant clinical trials and studies regarding the use of NOACs for the prevention of stroke or SEE in patients with atrial fibrillation. RESULTS: Relative to warfarin, NOACs are as effective or superior in the prevention of stroke or SEE, and are associated with similar or lower rates of major bleeding and significantly decreased rates of intracranial bleeding, but may be associated with a slightly increased risk of gastrointestinal bleeding in patients with AF. The NOACs are not indicated for use and have not been widely tested in AF patients with other cardiovascular conditions. Additional ongoing and planned clinical trials will provide additional information regarding the use of NOACs in these patients. In situations requiring rapid reversal of anticoagulation, the availability of specific antidotes will improve safety and facilitate NOAC use. CONCLUSIONS: Use of NOACs in clinical practice requires consideration of patient characteristics as well as potentially required procedures.
Entities:
Keywords:
atrial fibrillation; nonvitamin K oral anticoagulant; stroke; systemic embolism
Authors: Christopher B Fordyce; Anne S Hellkamp; Yuliya Lokhnygina; Samuel M Lindner; Jonathan P Piccini; Richard C Becker; Scott D Berkowitz; Günter Breithardt; Keith A A Fox; Kenneth W Mahaffey; Christopher C Nessel; Daniel E Singer; Manesh R Patel Journal: Circulation Date: 2016-07-05 Impact factor: 29.690
Authors: Craig T January; L Samuel Wann; Joseph S Alpert; Hugh Calkins; Joaquin E Cigarroa; Joseph C Cleveland; Jamie B Conti; Patrick T Ellinor; Michael D Ezekowitz; Michael E Field; Katherine T Murray; Ralph L Sacco; William G Stevenson; Patrick J Tchou; Cynthia M Tracy; Clyde W Yancy Journal: Circulation Date: 2014-03-28 Impact factor: 29.690
Authors: Rangadham Nagarakanti; Michael D Ezekowitz; Jonas Oldgren; Sean Yang; Michael Chernick; Timothy H Aikens; Greg Flaker; Josep Brugada; Gabriel Kamensky; Amit Parekh; Paul A Reilly; Salim Yusuf; Stuart J Connolly Journal: Circulation Date: 2011-01-03 Impact factor: 29.690
Authors: Michela Brambatti; Harald Darius; Jonas Oldgren; Andreas Clemens; Herbert H Noack; Martina Brueckmann; Salim Yusuf; Lars Wallentin; Michael D Ezekowitz; Stuart J Connolly; Jeff S Healey Journal: Int J Cardiol Date: 2015-05-28 Impact factor: 4.164
Authors: William Schuyler Jones; Anne S Hellkamp; Jonathan Halperin; Jonathan P Piccini; Gunter Breithardt; Daniel E Singer; Keith A A Fox; Graeme J Hankey; Kenneth W Mahaffey; Robert M Califf; Manesh R Patel Journal: Eur Heart J Date: 2013-12-02 Impact factor: 29.983
Authors: Robert P Giugliano; Christian T Ruff; Eugene Braunwald; Sabina A Murphy; Stephen D Wiviott; Jonathan L Halperin; Albert L Waldo; Michael D Ezekowitz; Jeffrey I Weitz; Jindřich Špinar; Witold Ruzyllo; Mikhail Ruda; Yukihiro Koretsune; Joshua Betcher; Minggao Shi; Laura T Grip; Shirali P Patel; Indravadan Patel; James J Hanyok; Michele Mercuri; Elliott M Antman Journal: N Engl J Med Date: 2013-11-19 Impact factor: 91.245