Apixaban In Patients With Atrial Fibrillation: Patient Characteristics Of The Latin America Cohort From A Multinational Clinical Trial

Avezum, Álvaro; Bahit, M. Cecilia; Ja, Hermosillo; Zanetti, FL; Perafán, Pablo; Juarez-Garcia, A.; Vulcano, Cristina; Cubillos, Luis A.; Donato, BM Korenblat

doi:10.1016/j.jval.2015.09.097

Cited by 2 publications

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“…These constituted more than Dose reduction edoxaban in NVAF and VTE: 30 mg od where one of CrCl 15-49 mL/min, body weight ≤60kg, concomitant use of cyclosporin, dronedarone, erythromycin or ketoconazole ACS = acute coronary syndrome; bd = twice per day; CrCl = creatinine clearance; LMWH = low molecular weight heparin; NICE = National Institute for Health and Care Excellence; NOAC = non-vitamin K oral anticoagulant; NVAF = non-valvular atrial fibrillation; od = once daily; P-gp = P glycoprotein; T max = time to peak level post ingestion; ULN = upper limit of normal; VTE = venous thromboembolism 25% of the study population in the ARISTOTLE (Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation) trial; the efficacy and safety benefits of apixaban were preserved in these patients despite the greater risk of thromboembolic disease and bleeding associated with both apixaban and warfarin. 9 Similar findings were obtained with dabigatran 10 and with rivaroxaban although bleeding was higher in the rivaroxaban arm. 11 In conclusion, NOACs are a reasonable choice of anticoagulant in patients with AF with some forms of valvular disease taking into account the individual drug properties.…”

Section: Patients With Valvular Heart Diseasesupporting

confidence: 65%

Drug therapy in anticoagulation: which drug for which patient?

Millar

Laffan

2017

Clinical Medicine

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Four non-vitamin K oral anticoagulants (NOACs) are now licensed and available in the UK, offering unprecedented choices in anticoagulant therapy for clinicians and patients. NOACs have many clear benefi ts over warfarin, the most striking being the reduction in intracranial haemorrhage. However, a number of uncertainties remain: their effi cacy in certain situations, utility of drug assays, signifi cance of drug interactions and management of bleeding. In the absence of any direct comparative trials, it is not clear that any of the NOACs is signifi cantly better than the others in any of the licensed indications. The differential activities, pharmacokinetics, metabolism, excretion and side effects of the agents should be considered when selecting the most appropriate anticoagulant. In this article, we discuss how, with careful selection for the relevant indication, NOACs can simplify therapy while improving outcomes. We aim to provide clinicians with the information needed to select the most suitable anticoagulant drug for an individual patient in a given situation. KEYWORDS : Anticoagulant therapy , non-vitamin K oral anticoagulants , NOACs IntroductionThe non-vitamin K oral anticoagulants (NOACs) 1 are now established in UK practice and new members continue to arrive. Within their licensed indications they have clear benefits over warfarin, but a number of uncertainties remain: efficacy in some specific situations, the utility of drug assays, significance of drug interactions and the management of bleeding all suffer from a paucity of data.This article provides an update on developments since the 2014 review in this journal.2 Our aim is to provide the information needed to select the most suitable anticoagulant drug for an individual patient in a given situation. ABSTRACTDrug therapy in anticoagulation: which drug for which patient? Properties of NOACsFour NOACs are now licensed and available in the UK: the direct factor Xa (FXa) inhibitors apixaban, edoxaban and rivaroxaban, and the direct thrombin inhibitor dabigatran. The key to best choice of agent lies in their individual pharmacokinetic profiles, metabolism and routes of excretion.

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Section: Patients With Valvular Heart Diseasesupporting

confidence: 65%

Drug therapy in anticoagulation: which drug for which patient?

Millar

Laffan

2017

Clinical Medicine

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“…Further subgroup analysis of the Latin American cohort suggests that results in terms of safety and efficacy are consistent with those seen in total study population, with minimal geographic variability within the region. 52 …”

Section: Methodsmentioning

confidence: 99%

Stroke Prevention in Atrial Fibrillation: Focus on Latin America

Massaro¹,

Lip²

2016

Arquivos Brasileiros De Cardiologia

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Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia, with an estimated prevalence of 1-2% in North America and Europe. The increased prevalence of AF in Latin America is associated with an ageing general population, along with poor control of key risk factors, including hypertension. As a result, stroke prevalence and associated mortality have increased dramatically in the region. Therefore, the need for effective anticoagulation strategies in Latin America is clear. The aim of this review is to provide a contemporary overview of anticoagulants for stroke prevention.The use of vitamin K antagonists (VKAs, eg, warfarin) and aspirin in the prevention of stroke in patients with AF in Latin America remains common, although around one fifth of all AF patients receive no anticoagulation. Warfarin use is complicated by a lack of access to effective monitoring services coupled with an unpredictable pharmacokinetic profile. The overuse of aspirin is associated with significant bleeding risks and reduced efficacy for stroke prevention in this patient group. The non-VKA oral anticoagulants (NOACbs) represent a potential means of overcoming many limitations associated with VKA and aspirin use, including a reduction in the need for monitoring and a reduced risk of hemorrhagic events.The ultimate decision of which anticoagulant drug to utilize in AF patients depends on a multitude of factors. More research is needed to appreciate the impact of these factors in the Latin American population and thereby reduce the burden of AF-associated stroke in this region.

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Apixaban In Patients With Atrial Fibrillation: Patient Characteristics Of The Latin America Cohort From A Multinational Clinical Trial

Cited by 2 publications

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Drug therapy in anticoagulation: which drug for which patient?

Drug therapy in anticoagulation: which drug for which patient?

Stroke Prevention in Atrial Fibrillation: Focus on Latin America

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