Ertunc Altiok1, Nikolaus Marx. 1. Department of Cardiology, Angiology and Intensive Care Medicine (Department of Internal Medicine I), University Hospital Aachen, RWTH Aachen University, Aachen, Germany.
Abstract
BACKGROUND: Much new evidence on oral anticoagulation has come to light in recent years. Non-vitamin-K-dependent oral anti- coagulants (NOAC) have been developed and have been introduced into clinical practice. In this review, we present the current state of the evidence on anticoagulation for various indications with vitamin K antagonists (VKA) and with NOAC. METHODS: This review is based on pertinent articles retrieved by a selective search in PubMed (search terms: anticoagulation, atrial fibrillation, prosthetic valve, thrombosis, pulmonary embolism) and on specialty society recommendations and relevant guidelines from the years 2000-2018. RESULTS: The main indications for oral anticoagulation are atrial fibrillation, venous thromboembolism, and status post heart valve replacement. In patients with atrial fibrillation and without valvular heart disease, anticoagulation is recommended for men with a CHA2DS2-VASc score ≥ 1 and for women with a score ≥ 2. NOAC for this indication are associated with a marginally lower rate of stroke than VKA (3.5% vs. 3.8%, number needed to treat [NNT] = 333) as well as a lower rate of major hemorrhage (5.1% vs. 6.2%, NNT = 91). NOAC are contraindicated for patients with mechanical heart valves. Anticoagulation with VKA can be predictably antagonized. Among the various types of NOAC, the anticoagulant effect of dabigatran can be safely antagonized with an antidote; no specific antidote is yet available for apixaban, rivaroxaban, or edoxaban. CONCLUSION: The evidence base for anticoagulation over a time frame of several years is inadequate at present, and direct comparative data for the different types of NOAC are not yet available.
BACKGROUND: Much new evidence on oral anticoagulation has come to light in recent years. Non-vitamin-K-dependent oral anti- coagulants (NOAC) have been developed and have been introduced into clinical practice. In this review, we present the current state of the evidence on anticoagulation for various indications with vitamin K antagonists (VKA) and with NOAC. METHODS: This review is based on pertinent articles retrieved by a selective search in PubMed (search terms: anticoagulation, atrial fibrillation, prosthetic valve, thrombosis, pulmonary embolism) and on specialty society recommendations and relevant guidelines from the years 2000-2018. RESULTS: The main indications for oral anticoagulation are atrial fibrillation, venous thromboembolism, and status post heart valve replacement. In patients with atrial fibrillation and without valvular heart disease, anticoagulation is recommended for men with a CHA2DS2-VASc score ≥ 1 and for women with a score ≥ 2. NOAC for this indication are associated with a marginally lower rate of stroke than VKA (3.5% vs. 3.8%, number needed to treat [NNT] = 333) as well as a lower rate of major hemorrhage (5.1% vs. 6.2%, NNT = 91). NOAC are contraindicated for patients with mechanical heart valves. Anticoagulation with VKA can be predictably antagonized. Among the various types of NOAC, the anticoagulant effect of dabigatran can be safely antagonized with an antidote; no specific antidote is yet available for apixaban, rivaroxaban, or edoxaban. CONCLUSION: The evidence base for anticoagulation over a time frame of several years is inadequate at present, and direct comparative data for the different types of NOAC are not yet available.
Authors: A John Camm; Paulus Kirchhof; Gregory Y H Lip; Ulrich Schotten; Irene Savelieva; Sabine Ernst; Isabelle C Van Gelder; Nawwar Al-Attar; Gerhard Hindricks; Bernard Prendergast; Hein Heidbuchel; Ottavio Alfieri; Annalisa Angelini; Dan Atar; Paolo Colonna; Raffaele De Caterina; Johan De Sutter; Andreas Goette; Bulent Gorenek; Magnus Heldal; Stefan H Hohloser; Philippe Kolh; Jean-Yves Le Heuzey; Piotr Ponikowski; Frans H Rutten Journal: Eur Heart J Date: 2010-08-29 Impact factor: 29.983
Authors: Agnes Y Y Lee; Mark N Levine; Ross I Baker; Chris Bowden; Ajay K Kakkar; Martin Prins; Frederick R Rickles; Jim A Julian; Susan Haley; Michael J Kovacs; Michael Gent Journal: N Engl J Med Date: 2003-07-10 Impact factor: 91.245
Authors: Stuart J Connolly; Michael D Ezekowitz; Salim Yusuf; John Eikelboom; Jonas Oldgren; Amit Parekh; Janice Pogue; Paul A Reilly; Ellison Themeles; Jeanne Varrone; Susan Wang; Marco Alings; Denis Xavier; Jun Zhu; Rafael Diaz; Basil S Lewis; Harald Darius; Hans-Christoph Diener; Campbell D Joyner; Lars Wallentin Journal: N Engl J Med Date: 2009-08-30 Impact factor: 91.245
Authors: Michael Metze; Christian Pfrepper; Tristan Klöter; Stephan Stöbe; Roland Siegemund; Thomas Siegemund; Elvira Edel; Ulrich Laufs; Sirak Petros Journal: Res Pract Thromb Haemost Date: 2020-04-23
Authors: Joachim Runge; Luisa Cassini Ascencao; Christian Blahak; Thomas M Kinfe; Christoph Schrader; Marc E Wolf; Assel Saryyeva; Joachim K Krauss Journal: Acta Neurochir (Wien) Date: 2021-08-03 Impact factor: 2.216