Non-vitamin K oral anticoagulant treatment in elderly patients with atrial fibrillation and coronary heart disease

Post-polypectomy bleeding and thromboembolism risks associated with warfarinvsdirect oral anticoagulants

“…The number of oral anticoagulants (AC) used for prophylaxis or treatment of thromboembolic events is expected to increase as the population ages[ 1 , 2 ]. Along with this, the number of colonoscopic polypectomies, the most common high-risk endoscopic procedure, is also expected to increase in patients receiving AC[ 3 - 5 ].…”

“…Physicians are thus confronted with the issue of striking a balance between performing procedures with bleeding risk, such as polypectomy, and temporarily discontinuing AC agents to mitigate thromboembolic risk[ 4 , 6 - 8 ]. Among the AC agents commonly prescribed, warfarin requires careful and complex management because of its intricate pharmacodynamics and narrow therapeutic range[ 2 , 9 ], whereas direct oral anticoagulants (DOAC) offer easier management because of the rapid onset of anticoagulation and short half-lives[ 10 ]. However, whether post-polypectomy bleeding (PPB) or thromboembolic risk differs between warfarin and DOAC users remains unknown.…”

Non-ST elevation acute coronary syndrome in women and the elderly: recent updates and stones still left unturned

“…The 2016 ACC/AHA focused update suggests that in patients with high risk of bleeding (for example, taking an oral anticoagulant medication) or high risk of bleeding complication, discontinuation of P2Y12 medication at 6 months after NSTEMI treated with drug-eluting stent(s) could be considered (class of recommendation IIb and level of evidence C-LD) 32 . Other considerations to reduce bleeding include the addition of proton pump inhibitors for those at risk of gastrointestinal bleeding while on DAPT, narrowing the international normalized ratio goal to 2.0 to 2.5 if on warfarin, and switching triple therapy to dual earlier on (that is, triple therapy for 1 month post-percutaneous coronary intervention, or post-PCI, followed by DOAC with only clopidogrel or aspirin for 11 months) 32, 33 . During an NSTEMI, reduced bleeding risk may be achieved by using bivalirudin, a direct thrombin inhibitor, in the elderly instead of glycoprotein IIb/IIIa inhibitor with unfractionated heparin 1 .…”

Analysis of Emergency Service Admissions in Patients with Oral Anticoagulant Usage

“…Vitamin K antagonisti oral antikoagülanlar (varfarin), tromboembolik hastalıklardan korunmak ve tedavi amacıyla uzun zamandır kullanılmaktadır (1) . Varfarin, vitamin K epoksit redüktazı hedefleyerek vitamin K bağımlı pıhtılaşma faktörlerinin fonksiyonel seviyesini azaltır (2) .…”

“…Tedavinin amacı INR'nin terapötik aralıkta tutulması ve bu sayede hastaların düşük hemorajik ve trombotik riskte olmasını sağlamaktır (4) . Yeni geliştirilen direkt oral antikoagülanlar (DOAK), varfarini tromboembolik hastalıklarda kullanılan tek oral antikoagülan (OAK) olmaktan çıkarmıştır (1) . Direkt oral antikoagülanlar olarak kullanılan hâlihazırda dört adet preparat bulunmaktadır (dabigatran, apiksaban, rivaroksaban ve edoksaban) ve bunlar venöz tromboemboli ve inme profilaksisinde kullanılmaktadırlar.…”