Novel anticoagulants – an update on the latest developments and management for clinicians treating patients on these drugs

Green, Ben; Mendes, Rui Amaral; Valk, Ruben Van der; Brennan, Peter A.

doi:10.1111/jop.12441

Cited by 12 publications

(17 citation statements)

References 41 publications

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“…Warfarin is an oral anticoagulant widely prescribed for a variety of thromboembolic indications including venous thromboembolism (VTE), deep vein thrombosis (DVT) and the prevention of stroke associated for atrial fibrillation (AF) . Warfarin requires ongoing monitoring of Internationalised Normalised Ratio (INR) due to a narrow therapeutic index and interactions with numerous drugs .…”

mentioning

confidence: 99%

Impact of Aspirin on Warfarin Control as Measured by Time in Therapeutic Range

Boyce

Zayac

Davis

et al. 2018

Basic Clin Pharma Tox

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mentioning

confidence: 99%

Impact of Aspirin on Warfarin Control as Measured by Time in Therapeutic Range

Boyce

Zayac

Davis

et al. 2018

Basic Clin Pharma Tox

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“…The rest of dental procedures are associated with standard and high bleeding risk, and such cases do require temporary discontinuation of edoxaban. Since there is no scientific basis for discontinuing edoxaban prior to performing dental treatment, when to stop it depends on the pharmacokinetics and pharmacodynamics of the drug and on the patient’s renal function (impaired renal function involves slower clearance of the oral anticoagulant by renal excretion) ( 20 - 35 ). Table 1 shows the guidelines for edoxa-ban discontinuation.…”

Section: Methodsmentioning

confidence: 99%

Managing patients taking edoxaban in dentistry

Curto

Sánchez

2017

J Clin Exp Dent

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BackgroundAnticoagulation therapy is used in several conditions to prevent or treat thromboembolism. A new group of oral anticoagulants with clear advantages over classic dicoumarin oral anticoagulants (warfarin and acenocoumarol) has been developed in recent years. The Food and Drug Administration has approved edoxaban, dabigatran, rivaroxaban and apixaban. Their advantages include: predictable pharmacokinetics, drug interactions and limited food, rapid onset of action and short half-life. However, they lack a specific reversal agent.Material and MethodsThis paper examines the available evidence regarding rivaroxaban and sets out proposals for clinical guidance of dental practitioners treating these patients in primary dental care. A literature search was conducted through July 2016 for publications in PubMed and Cochrane Library using the keywords “edoxaban”, “dabigatran”, “rivaroxaban”, “apixaban”, “new oral anticoagulants”, “novel oral anticoagulants”, “bleeding” and “dental treatment” with the “and” boolean operator in the last 10 years.ResultsThe number of patients taking edoxaban is increasing. There is no need for regular coagulation monitoring of patients on edoxaban therapy. For patients requiring minor oral surgery procedures, interruption of edoxaban is not generally necessary. Management of patients on anticoagulation therapy requires that dentists can accurately assess the patient prior to dental treatments.ConclusionsTheir increased use means that oral care clinicians should have a sound understanding of the mechanism of action, pharmacology, reversal strategies and management of bleeding in patients taking edoxaban. There is a need for further clinical studies in order to establish more evidence-based guidelines for dental patients requiring edoxaban. Key words:Edoxaban, dabigatran, rivaroxaban, apixaban, novel oral anticoagulants, bleeding.

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“…Warfarin is an oral anticoagulant widely used for numerous indications including deep vein thrombosis (DVT) and prevention of stroke associated with atrial fibrillation (AF) . Warfarin requires close monitoring of International Normalised Ratio (INR) because of a narrow therapeutic index and extensive list of interacting medications .…”

Section: Introductionmentioning

confidence: 99%

Proton pump inhibitors co‐prescribed with warfarin reduce warfarin control as measured by time in therapeutic range

et al. 2019

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Introduction Warfarin is an oral anticoagulant that requires ongoing monitoring with time in therapeutic range (TTR), a common measure of the quality of warfarin control and likelihood of adverse events including bleeds. Numerous factors can influence these warfarin outcomes including drug interactions. Proton pump inhibitors (PPIs) have been reported to interact with warfarin but there remain conflicting reports with regard to the impact on bleeds and limited data on TTR. Therefore, the aim of this study was to determine the effect of PPIs on warfarin control using TTR and bleeds as endpoints. Methods Retrospective data were collected for patients managed by a warfarin management clinic in Queensland. Data collected included current medications, reported bleeds and INR results to calculate TTR. Patients were grouped as taking PPIs or not taking PPIs. Analysis of TTR and bleeds occurred for these groups both before and after exclusions of other medication reported to interact with warfarin. Results Of the 4494 included patients, almost half (44.5%) were taking PPIs with esomeprazole most commonly (34.8%) prescribed. Patients taking PPIs had significantly reduced TTR compared with patients not taking PPIs both before (78.5 ± 9.7% vs 81.7 ± 10.2%, P < 0.0001) and after (84.4 ± 5.1% vs 89.4 ± 8.0%, P < 0.0001) excluding all other interacting medications with warfarin. Patients taking PPIs also had significantly higher incidence of minor bleeds compared with patients not taking PPIs (32.4% vs 26.1%, P = 0.0487). Discussion Patients taking PPIs with warfarin had significantly lower TTRs and higher incidence of minor bleeds. This combination warrants additional caution and monitoring with warfarin control as measured by TTR potentially affected.

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Novel anticoagulants – an update on the latest developments and management for clinicians treating patients on these drugs

Cited by 12 publications

References 41 publications

Impact of Aspirin on Warfarin Control as Measured by Time in Therapeutic Range

Impact of Aspirin on Warfarin Control as Measured by Time in Therapeutic Range

Managing patients taking edoxaban in dentistry

Proton pump inhibitors co‐prescribed with warfarin reduce warfarin control as measured by time in therapeutic range

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