Predictors of NOAC versus VKA use for stroke prevention in patients with newly diagnosed atrial fibrillation: Results from GARFIELD-AF

Haas, Sylvia; Camm, A. John; Bassand, Jean‐Pierre; Angchaisuksiri, Pantep; Cools, Frank; Corbalán, Ramón; Gibbs, Harry; Jacobson, Barry; Koretsune, Yukihiro; Mantovani, Lorenzo Giovanni; Misselwitz, Frank; Панченко, Е. П.; Ragy, Hany; Stępińska, Janina; Turpie, Alexander G. G.; Sawhney, J.P.S.; Steffel, Jan; Lim, Toon Wei; Pieper, Karen S.; Virdone, Saverio; Verheugt, Freek W.A.; Kakkar, Ajay K.; Investigators, Garfield‐Af

doi:10.1016/j.ahj.2019.03.013

Cited by 53 publications

(46 citation statements)

References 51 publications

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“…For example, the Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF; a large registry of newly diagnosed AF cases) included 2623 patients with moderate-to-severe CKD (stage 3-5), of whom 45.8% were placed on DOACs. 105 Based on these registry data and clinical trials, DOACs appear to be safe in patients with moderate CKD. A recent Cochrane review evaluated 12,545 patients with CKD across 5 large clinical trials who were randomized to a DOAC (apixaban, rivaroxaban, edoxaban, or dabigatran).…”

Section: Ckd and Eskdmentioning

confidence: 98%

Role of direct oral anticoagulants in patients with kidney disease

Derebail

Rheault

Kerlin

2020

Kidney International

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The anticoagulation field is experiencing a renaissance that began with regulatory approval of the direct thrombin inhibitor dabigatran, a direct oral anticoagulant (DOAC), in 2010. The DOAC medication class has rapidly evolved to include the additional approval of 4 direct factor Xa inhibitors. Commensurately, DOAC use has increased and collectively account for the majority of new anticoagulant prescriptions. Despite exclusion of patients with moderateto-severe kidney disease from most pivotal DOAC trials, DOACs are increasingly used in this setting. An advantage of DOACs is similar or improved antithrombotic efficacy with less bleeding risk when compared with traditional agents. Several post hoc analyses, retrospective studies, claims data studies, and meta-analyses suggest that these benefits extend to patients with kidney disease. However, the lack of randomized controlled trial data in specific kidney disease settings, with their unique pathophysiology, should be a call to action for the kidney community to systematically study these agents, especially because early data suggest that DOACs may pose less risk of anticoagulant-related nephropathy than do vitamin K antagonists. Most DOACs are renally cleared and are significantly protein bound in circulation; thus, the pharmacokinetics of these drugs are influenced by reduced renal function and proteinuria. DOACs are susceptible to altered metabolism by P-glycoprotein inhibitors and inducers, including drugs commonly used for the management of kidney disease comorbidities. We summarize the currently available literature on DOAC use in kidney disease and illustrate knowledge gaps that represent important opportunities for prospective investigation.

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Section: Ckd and Eskdmentioning

confidence: 98%

Role of direct oral anticoagulants in patients with kidney disease

Derebail

Rheault

Kerlin

2020

Kidney International

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“…The total sample size was 8, 80, 213 patients. One study was performed in Germany, 26 one in Italy, 27 four in Canada, 28,29,32,36 nine in the United States, 30, 31, 33-35, 37, 38, 40, 41 and one in Israel 39 . Sample sizes were less than 1000 in five of the studies, 1000-15,000 in five of the studies, 20,000-75,000 in five of the studies, and more than 5,00,000 in one of the studies.…”

Section: Resultsmentioning

confidence: 99%

“…39,40,46 It was also found that patients with comorbid conditions like hypertension, coronary artery disease (CAD), peripheral artery disease (PAD), diabetes, and heart failure were more likely to be prescribed warfarin than NOACs. 26,29,32,[39][40][41] Relatively, reduction in anticoagulant prescription is associated with fewer conditions. A wide range of cardiac disorders are associated with an increase in the utilization of anticoagulants, which might be due to increased visit of patients with physicians who are more inclined to start anticoagulants.…”

Section: Discussionmentioning

confidence: 99%

Predictors of Oral Anticoagulants Utilization in Patients with Atrial Fibrillation

Sankhi

Marasine

Lamichhane³

et al. 2020

jhas

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Introduction: Atrial fibrillation (AF) is the most common sustained cardiac rhythm disturbance, increasing in prevalence with age. It is often associated with structural heart disease, although a substantial proportion of patients with AF have no detectable heart disease. Hemodynamic impairment and thromboembolic events related to AF result in significant morbidity, mortality, and cost. Several factors are associated with the prescription of oral anticoagulants. This review predicts the overall factors that are associated with oral anticoagulant utilization in patients with AF. Methods: Literatures that analyze the predictors of oral anticoagulant utilization in atrial fibrillation were searched using PubMed and Google Scholar published in journals from 2003 to 2019. Eligibility, data extraction and quality assessment were followed by a narrative synthesis of data. An extensive search of recent literature was performed. Results: Older age, comorbidities like hypertension, diabetes, heart failure, coronary artery disease, peripheral artery disease, moderate to severe kidney disease, polypharmacy, higher stroke and bleeding risk, history of smoking and alcohol or substance abuse, and lower cost are predictors of warfarin utilization. Similarly, younger age, better kidney function with creatinine clearance at least 30 mL/min, no or lower risk of stroke and hemorrhage, no polypharmacy, less comorbidities, prescriptions by neurologists and cardiologist, people residing in countries with lower poverty rates, and high cost are potential predictors of non-vitamin K antagonist oral anticoagulants utilization. Conclusion: Our study suggests that knowing the predictors for anticoagulation utilization can improve medication appropriateness in arterial fibrillation patients.

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“…Previous reports have stated the clinical effectiveness of NOACs in patients with non-valvular AF [3][4][5][6]. Due to good compliance and effectiveness, the use of NOACs is increasing, but clinical experience is still limited [7]. In the present study, we investigated whether patients under NOACs exhibit a lower incidence of…”

Section: Introductionmentioning

confidence: 93%

Prevalence and Clinical Correlates of Spontaneous Echo Contrast in Patients on Oral Anticoagulation Undergoing Catheter Ablation for Atrial Fibrillation

Grebmer¹,

Lennerz²,

Brkić³

et al. 2019

Int J Clin Cardiol

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Background: Spontaneous echo contrast (SEC) in the left atrial appendage (LAA) is associated with an increased risk of cerebral embolism in patients with atrial fibrillation (AF). Novel oral anticoagulants (NOACs) are increasingly prescribed as first-line therapy and have shown a comparable benefit-risk ratio compared to vitamin K antagonists (VKAs). The aim of this study was to investigate whether NOACs decrease the incidence of SEC compared to VKA. Methods: We retrospectively analysed 542 patients who underwent transoesophageal echocardiography (TEE) prior to AF ablation at our institution. SEC was characterised by dynamic, smoke-like echoes within the LA cavity or LAA on TEE. Results: SEC was detected in 58 patients (10.7%) and occurred significantly more often in patients on VKA (n = 39; 13.6%) compared to patients on NOACs (n = 19, 7.5%; p = 0.02). Decreased left ventricular function (p < 0.001), arterial hypertension (p < 0.001), LA enlargement (p < 0.001) and AF during TEE (p < 0.001) were significantly more often observed in patients showing SEC. Transient ischemic attack or stroke did not occur in any patient during AF ablation. Conclusion: The incidence of SEC on TEE in patients prior to AF ablation was significantly lower in patients treated with NOACs as compared to patients treated with VKA. Patients with multiple risk factors showed a higher SEC incidence. The results support the recommendation of NOACs as firstline oral anticoagulation in non-valvular AF.

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Predictors of NOAC versus VKA use for stroke prevention in patients with newly diagnosed atrial fibrillation: Results from GARFIELD-AF

Cited by 53 publications

References 51 publications

Role of direct oral anticoagulants in patients with kidney disease

Role of direct oral anticoagulants in patients with kidney disease

Predictors of Oral Anticoagulants Utilization in Patients with Atrial Fibrillation

Prevalence and Clinical Correlates of Spontaneous Echo Contrast in Patients on Oral Anticoagulation Undergoing Catheter Ablation for Atrial Fibrillation

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