Direct oral anticoagulants: Current indications and unmet needs in the treatment of venous thromboembolism

Bertoletti, Laurent; Ollier, Édouard; Duvillard, Cécile; Delavenne, Xavier; Beyens, Marie-Noëlle; Magalhaes, Élodie De; Bellet, Florelle; Basset, Thierry; Mismetti, Patrick; Laporte, Silvy

doi:10.1016/j.phrs.2016.06.023

Cited by 33 publications

(36 citation statements)

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“…Moreover, monitoring of the drug effects is also difficult and not routinely established so far. 66,67 Drug and food interactions DOACs have only a few pharmacokinetic interactions of mild character with other commonly administered drugs. 68 Rivaroxaban and dabigatran are substrates of the efflux transporter P-glycoprotein which is induced by rifampicin and inhibited by ketoconazole and dronedarone.…”

Section: Monitoring and Safetymentioning

confidence: 99%

Direct oral anticoagulants in patients with chronic kidney disease: patient selection and special considerations

Lutz

Jurk²,

Schinzel³

2017

IJNRD

104

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Many patients with chronic kidney disease (CKD) receive anticoagulation or antiplatelet therapy due to atrial fibrillation, coronary artery disease, thromboembolic disease, or peripheral artery disease. The treatment usually includes vitamin K antagonists (VKAs) and/or platelet aggregation inhibitors. The direct oral anticoagulants (DOAC) inhibiting factor Xa or thrombin represent an alternative for VKAs. In patients with acute and chronic kidney disease, caution is warranted, as DOACs can accumulate as they are partly eliminated by the kidneys. Thus, they can potentially increase the bleeding risk in patients with CKD. In patients with an estimated glomerular filtration rate (eGFR) above 60 mL/min, DOACs can be used safely with greater efficacy and safety as compared to VKAs. In patients with CKD 3, DOACs are as effective as VKAs with a lower bleeding rate. The more the renal function declines, the lower is the advantage of DOACs over VKAs. Thus, use of DOACs should be avoided in patients with an eGFR below 30 mL/min, particularly, the compounds with a high renal elimination. Available data suggest that DOACs can also be used safely in older patients. In this review, use of DOACs in comparison with VKAs, heparins, and heparinoids, together with special considerations in patients with impaired renal function will be discussed.

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Section: Monitoring and Safetymentioning

confidence: 99%

Direct oral anticoagulants in patients with chronic kidney disease: patient selection and special considerations

Lutz

Jurk²,

Schinzel³

2017

IJNRD

104

View full text Add to dashboard Cite

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“…Pharmacokinetic interaction, which constitutes the highest risk of interaction, modifying the medication concentration, is mainly represented by statin and amiodarone, involved in about 55% of cases. These medications can however be justified in this population with cardiovascular history, and occur as often as in the populations included in the phase III studies [14–18]. The clinical impact of such interactions is debatable.…”

Section: Discussionmentioning

confidence: 99%

Areas of improvement in anticoagulant safety. Data from the CACAO study, a cohort in general practice

Frappé¹,

Cogneau²,

Gaboreau³

et al. 2017

PLoS ONE

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BackgroundReal-world studies on anticoagulants are mostly performed on health insurance databases, limited to reported events, and sometimes far from every-day issues in family practice. We assess the presence of data for safe monitoring of oral anticoagulants in general practice, and compare patients’ knowledge of taking an anticoagulant between vitamin K antagonists (VKA) and direct anticoagulants (DOAC), and the general practitioner’s perception of their adherence to anticoagulation.MethodsThe CACAO study is a national cohort study, conducted by general practitioners on ambulatory patients under oral anticoagulant. In the first phase, investigators provided safety data available from medical records at inclusion. They also evaluated patients’ knowledge about anticoagulation and graded their perception of patients’ adherence.ResultsBetween April and December 2014, 463 general practitioners included 7154 patients. Renal and hepatic function tests were respectively unavailable in 109 (7.5%) and 359 (24.7%) DOAC patients. Among patients with atrial fibrillation, 345 patients (6.9%) had a questionable indication of anticoagulant (CHA2DS2-Vasc<2). One hundred and thirty-three VKA patients (2.3%) and 70 DOAC patients (4.9%) answered they took no anticoagulant (p<0.0001). According to general practitioners’ perception, 430 patients (6.1%) were classified as “not very” or “not adherent”, with no difference between groups.ConclusionsOur results highlight the efforts needed to improve anticoagulant safety in daily practice: decreasing the rate of unknown biological data in patients with DOACs or the rate of patients with VKA with no strong indication of anticoagulation, and improving patient knowledge with regard to their anticoagulant. Patients’ adherence seems highly over-estimated by the general practitioners.Clinical trial registrationClinicalTrials.gov NCT02376777

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“…Direct oral anticoagulants were evaluated for the acute treatment of VTE, as for the extended treatment (for some of them), in randomized controlled trials. 3 Results of phase 3 trials concluded that DOACs were non-inferior in terms of efficacy (recurrent VTE rates), but did better in terms of safety (less clinically relevant bleeding) than conventional anticoagulant therapy (VKA).…”

Section: Direct Oral Anticoagulants: Still Too Early For Prime Time Amentioning

confidence: 99%

Direct oral anticoagulants: Still too early for prime time after pulmonary endarteriectomy?

Bertoletti

Jaïs

Bezzeghoud

et al. 2020

Journal of Thrombosis and Haemostasis

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Direct oral anticoagulants: Current indications and unmet needs in the treatment of venous thromboembolism

Cited by 33 publications

References 100 publications

Direct oral anticoagulants in patients with chronic kidney disease: patient selection and special considerations

Direct oral anticoagulants in patients with chronic kidney disease: patient selection and special considerations

Areas of improvement in anticoagulant safety. Data from the CACAO study, a cohort in general practice

Direct oral anticoagulants: Still too early for prime time after pulmonary endarteriectomy?

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