Long-term prescribing of new oral anticoagulants

Chin, Paul; Doogue, Matthew

doi:10.18773/austprescr.2016.068

Cited by 14 publications

(8 citation statements)

References 23 publications

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“…11,12 Because AF is often poorly tolerated by heart failure patients in terms of symptom burden and risk of decompensation, one must consider rhythm control early in the treatment of a patient with signs of clinical heart failure and AF. 20,21 the above recommendations are applicable for patients with both AF and atrial flutter, and hold true irrespective of rate/rhythm control. Further, in the special case of 'valvular AF' (defined as the presence of a mechanical heart valve or moderateto-severe mitral stenosis), 12 warfarin therapy is the only effective recommended treatment option, and the newer OACs should not be used.…”

Section: Rate Versus Rhythm Controlmentioning

confidence: 96%

Atrial fibrillation

Verma¹,

Wong²

2019

Aust J Gen Pract

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Section: Rate Versus Rhythm Controlmentioning

confidence: 96%

Atrial fibrillation

Verma¹,

Wong²

2019

Aust J Gen Pract

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“…The choice of direct oral anticoagulant is individualised based on renal function, ability to adhere to the dosing schedule and the likely need for reversal of anticoagulation. 28 There are concerns that cryptogenic strokes may be due to undiagnosed paroxysmal atrial fibrillation, 29,30 creating the idea that anticoagulants may have a role even if the arrhythmia is not detected. 31,32 However, evidence to support this is lacking, and anticoagulants post stroke without evidence of atrial fibrillation are not recommended for secondary stroke prevention due to the increased risk of bleeding.…”

Section: Anticoagulants and Atrial Fibrillationmentioning

confidence: 99%

“…The choice of direct oral anticoagulant is individualised based on renal function, ability to adhere to the dosing schedule and the likely need for reversal of anticoagulation. 28 …”

Section: Anticoagulants and Atrial Fibrillationmentioning

confidence: 99%

Drugs in secondary stroke prevention

Tremonti¹,

Thieben²

2021

Aust Prescr

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After an ischaemic stroke or transient ischaemic attack, patients have a high risk of having another stroke. Secondary stroke prevention includes antiplatelet therapy, statins and antihypertensives.Aspirin, clopidogrel, or a combination of aspirin with dipyridamole are first-line options for secondary stroke prevention in the absence of atrial fibrillation.Dual antiplatelet therapy has a benefit in the first three weeks after stroke, but patients should change to a single antiplatelet drug after this time.Anticoagulants are indicated if the patient has atrial fibrillation. Avoid combinations of anticoagulants and antiplatelet drugs.Patients should be started on statins after an ischaemic stroke. High doses are recommended even if cholesterol concentrations are normal.Antihypertensive drugs are recommended for all patients with systolic blood pressures greater than 140/90 mmHg. ACE inhibitors, calcium channel blockers and diuretics are first-line options. Drugs in secondary stroke preventionthere was an increased risk of bleeding with the increased dose range, so typically doses of 75-150 mg are used. The benefit of aspirin has been shown to be even more marked for secondary stroke prevention in the first six weeks post stroke. 5 Aspirin/dipyridamoleDipyridamole should not be used alone in stroke prevention. In trials it was combined with aspirin, typically as aspirin 25 mg and dipyridamole 200 mg. This is an acceptable antiplatelet combination for patients with non-cardioembolic ischaemic stroke or transient ischaemic attack.The 2006 ESPRIT trial found that the combination of aspirin and dipyridamole had a benefit over aspirin alone with regard to secondary stroke risk, and nonfatal bleeding. 8 It is worth noting however that the majority of patients were randomised after more than one month, and so it is unclear if aspirin/dipyridamole has benefit over aspirin immediately after a stroke.Dipyridamole has a vasodilatory action and headache is a common adverse effect which may lower adherence to treatment. 9 Dipyridamole's vasodilatory effect also means care should be used in patients with unstable angina or aortic stenosis.

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“…The concurrent use of another anticoagulant or an antiplatelet agent would increase the risk of a bleed. The use of nonsteroidal anti-inflammatory drugs (NSAIDs), norepinephrine, or serotonin reuptake inhibitors (SNRI or SSRI) also increases bleeding risk [80]. Blood transfusion should be promptly started after intravenous fluids to correct the shock and establish hemodynamic stability.…”

Section: Treatmentmentioning

confidence: 99%

A Review of the Incidence Diagnosis and Treatment of Spontaneous Hemorrhage in Patients Treated with Direct Oral Anticoagulants

Gunasekaran

Rajasurya²,

Devasahayam

et al. 2020

JCM

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Anticoagulation carries a tremendous therapeutic advantage in reducing morbidity and mortality with venous thromboembolism and atrial fibrillation. For over six decades, traditional anticoagulants like low molecular weight heparin and vitamin K antagonists like warfarin have been used to achieve therapeutic anticoagulation. In the past decade, multiple new direct oral anticoagulants have emerged and been approved for clinical use. Since their introduction, direct oral anticoagulants have changed the landscape of anticoagulants. With increasing indications and use in various patients, they have become the mainstay of treatment in venous thromboembolic diseases. The safety profile of direct oral anticoagulants is better or at least similar to warfarin, but several recent reports are focusing on spontaneous hemorrhages with direct oral anticoagulants. This narrative review aims to summarize the incidence of spontaneous hemorrhage in patients treated with direct oral anticoagulants and also offers practical management strategies for clinicians when patients receiving direct oral anticoagulants present with bleeding complications.

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Long-term prescribing of new oral anticoagulants

Cited by 14 publications

References 23 publications

Atrial fibrillation

Atrial fibrillation

Drugs in secondary stroke prevention

A Review of the Incidence Diagnosis and Treatment of Spontaneous Hemorrhage in Patients Treated with Direct Oral Anticoagulants

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