New oral anticoagulants: a practical guide for clinicians

Wittkowsky, Ann K.

doi:10.1007/s11239-009-0409-0

Cited by 40 publications

(32 citation statements)

References 29 publications

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“…However, from a meta-analysis of available assays, the immediate conclusion is that there was no difference between dabigatran and enoxaparin in any of the endpoints analyzed. As for rivaroxaban, phase III clinical trials comparing it to enoxaparin -RECORD 1 (THA, n = 4,541), RECORD 2 (THA, n = 2,509), RECORD 3 (TKA, n = 2,531) and RECORD 4 (TKA, n = 3,148) -showed superiority of rivaroxaban to enoxaparin, and a meta-analysis confirmed these results (Wittkowsky, 2010).…”

Section: Assaysmentioning

confidence: 85%

“…Those agents are strong inhibitors of both CYP3A4 and p-GP. Comparatively, erythromycin is a moderate inhibitor of both CYP3A4 and p-GP, while clarithromycin is a strong CYP3A4 and a moderate p-GP inhibitor (Wittkowsky, 2010).…”

Section: Pharmacokinetic Parametersmentioning

confidence: 96%

“…Antacids and H 2 blockers have no impact on rivaroxaban, but no information is currently available about the effect of proton pump inhibitors. The effect of food, antacids, H 2 blockers and proton pump inhibitors on apixaban has not yet been reported (Wittkowsky, 2010).…”

Section: Pharmacokinetic Parametersmentioning

confidence: 99%

“…There is much more to be learned about the safety of these agents in patients with mild moderate and severe renal impairment, as well as in those with changing renal function (Wittkowsky, 2010).…”

Section: Pharmacokinetic Parametersmentioning

confidence: 99%

“…Nowadays, a convenient treatment increases adherence, and directly contributes to drug therapy success. In addition to these three requirements, the cost of treatment is also a constant concern, because a safe, effective and convenient therapy for the population is extremely limited, due to the high costs related (Wittkowsky, 2010). 656 Thesearch for anticoagulants with acceptable efficacy and safety associated with patient compliance has been extensive, and several drugs were developed.…”

Section: Introductionmentioning

confidence: 99%

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New perspectives and recommendations for anticoagulant therapy post orthopedic surgery

Kropf

Bergami

Leal

et al. 2011

Braz. J. Pharm. Sci.

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Anticoagulant therapy is essential for the prevention of risks associated with the formation of thrombus in patients after surgery, especially in orthopedics. Recently, new oral anticoagulants were introduced in the therapeutic arsenal. This fact is important, because the current drug of choice in clinical practice is enoxaparin, a low molecular weight heparin. As all injecting drugs, enoxaparin may reduce patients' adherence to treatment by dissatisfaction with and resistance to the administration. This article reviews the available literature on the overall utility of these innovative medicines, approaching the pharmacology, the compared efficacy in relation to current agents, and the potential targets for new agents, as well as points to new trends in research and development. The article also contributes with a practical guide for use and recommendations to health professionals, especially focusing on the reversibility of hemorrhagic events, and discusses the importance of convenience/satisfaction of use, the cost of treatment, and the risk-benefit profile for patients. A terapia anticoagulante é fundamental para a prevenção de riscos associados à formação de trombos em pacientes pós-cirúrgicos, principalmente em ortopedia. Recentemente, novos anticoagulantes orais foram introduzidos no arsenal terapêutico. Tal fato é importantíssimo, visto que o atual medicamento de primeira escolha na prática clínica é a enoxaparina, uma heparina de baixo peso molecular. Por ser de uso injetável, a enoxaparina pode diminuir a adesão do paciente ao tratamento, devido à insatisfação e à resistência quanto à via de administração. Este artigo revisa a literatura disponível sobre a utilidade total desses medicamentos inovadores ao abordar a farmacologia, a eficácia em comparação com os agentes atuais e os alvos potenciais para novos agentes, bem como aponta as novas tendências em pesquisa e desenvolvimento. O artigo também contribui com um guia prático de uso e recomendações aos profissionais de saúde, com um enfoque especial sobre a reversibilidade de eventos hemorrágicos e, finalmente, discute a importância da conveniência/satisfação de uso, o custo de tratamento e o perfil risco-benefício para o paciente.Unitermos: Anticoagulantes orais/use/adesão ao tratamento. Anticoagulantes injetáveis/uso/adesão ao tratamento. Terapia anticoagulante. Enoxaparina/uso. Dabigatrana/uso. Rivaroxabana/uso. Fármacos HPBM/uso.

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Section: Assaysmentioning

confidence: 85%

Section: Pharmacokinetic Parametersmentioning

confidence: 96%

Section: Pharmacokinetic Parametersmentioning

confidence: 99%

Section: Pharmacokinetic Parametersmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

New perspectives and recommendations for anticoagulant therapy post orthopedic surgery

Kropf

Bergami

Leal

et al. 2011

Braz. J. Pharm. Sci.

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Dabigatran etexilate: What do hospitalists need to know?

Zeidan

Faltas

Streiff

2011

Journal of Hospital Medicine

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Dabigatran etexilate (dabigatran) is a novel, oral, reversible, direct thrombin inhibitor that exhibits several advantages over warfarin for therapeutic anticoagulation. The predictable pharmacokinetic profile and minimal food and drug interactions of dabigatran allow for a fixed‐dosing regimen and obviate the need for routine laboratory monitoring. Dabigatran has been approved in the United States for prevention of stroke in patients with nonvalvular atrial fibrillation and in the European Union and other countries for primary prevention of thromboembolic events after total knee or hip replacement. More indications for the use of dabigatran are under review by regulatory authorities and are undergoing active clinical investigation. Due to its rapid onset of action, dabigatran may omit the need for a parenteral anticoagulant for acute treatment of thromboembolic conditions. Because wide‐scale use of dabigatran is expected in the near future, hospitalists need to familiarize themselves with this agent. The lack of a standardized reliable laboratory method to monitor the anticoagulant effects of dabigatran complicates verifying compliance, measuring the effects of drug interactions, evaluating cases of dabigatran toxicity, and conducting preoperative evaluations. The lack of an antidote to dabigatran complicates the management of toxicity and makes it largely supportive. The elimination of dabigatran is dependent on renal function, with the potential for drug accumulation and toxicity with renal impairment. The noninferiority design of the clinical trials that evaluated dabigatran and the absence of long‐term safety and efficacy data and issues related to the cost effectiveness of dabigatran should all be considered when prescribing this agent. Journal of Hospital Medicine 2011. © 2011 Society of Hospital Medicine.

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