Rules for using reduced doses of non-vitamin K antagonist oral anticoagulants in the prevention of thromboembolic complications in patients with atrial fibrillation. The expert opinion of the Working Group on Cardiovascular Pharmacotherapy of the Polish Cardiac Society

Gorczyca, Iwona; Kapłon‐Cieślicka, Agnieszka; Wełnicki, Marcin; Szymański, Filip M.; Barylski, Marcin; Mamcarz, Artur; Filipiak‬, Krzysztof J.; Wożakowska−Kapłon, Beata

doi:10.33963/kp.a2022.0286

Cited by 2 publications

(2 citation statements)

References 18 publications

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“…Definitions of the comorbidities were included in Supplementary material. Appropriateness of DOAC dose adjustments was categorized according to the approved labeling for each agent [ 16 , 17 ]. Non-persistence to the OAC regimen was based on self-reported instances of dose omission and/or brief interruptions.…”

Section: Methodsmentioning

confidence: 99%

Low bleeding acceptance is associated with increased death risk in patients with atrial fibrillation on oral anticoagulation

Rusin,

Konieczyńska,

Natorska

et al. 2023

J Thromb Thrombolysis

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Bleeding is the most feared complication of anticoagulation. We sought to investigate whether the bleeding risk acceptance has a prognostic value during long-term follow-up in the era of direct oral anticoagulants (DOACs) among patients with atrial fibrillation (AF). We studied 167 consecutive AF outpatients [aged 68.8 SD 10.6 years; 141 (84.4%) on DOACs]. The bleeding acceptance was assessed based on the Bleeding Ratio defined as the declared maximum number of major bleedings that a patient would be willing to accept to prevent one major stroke. We recorded cerebrovascular ischemic events, major or clinically relevant non-major bleeds (CRNMB), and mortality. A median Bleeding Ratio was 4 (IQR 2–5). During follow-up of 946 patient-years, cerebrovascular ischemic events and/or death were observed in 28 patients (3.3%/ year) and major bleeding or CRNMB in 33 (4.6%/ year). The Bleeding Ratio was lower in patients who experienced cerebrovascular events or death (p = 0.004), but not bleeding. Patients with the Bleeding Ratio 0–3 were more often non-persistent to the OAC therapy, and more likely to have cerebrovascular event or die than those with higher bleeding acceptance (odds ratio 2.55; 0.95% CI 1.08–6.02) which was driven by the impact on mortality. The multiple Cox proportional hazards model showed that lower Bleeding Ratio, higher CHA2DS2-VASc score, and older age predicted cerebrovascular events or death during follow-up. AF patients who are willing to accept fewer serious bleedings to avoid major stroke during anticoagulation are more likely to experience death and/or cerebrovascular ischemic events, but not bleeding, what might be related to non-persistence.

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Section: Methodsmentioning

confidence: 99%

Low bleeding acceptance is associated with increased death risk in patients with atrial fibrillation on oral anticoagulation

Rusin,

Konieczyńska,

Natorska

et al. 2023

J Thromb Thrombolysis

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“…Key words: andexanet alfa, antidote, apixaban, bleeding, non-vitamin K antagonist oral anticoagulants, rivaroxaban 2 and 3 [1,5].…”

Section: Fxa Inhibitor Action Mechanismsmentioning

confidence: 99%

The use of andexanet alpha in the Polish setting: An interdisciplinary protocol. Expert consensus statement of the Polish Cardiac Society

Kazimierczyk,

Dąbrowska,

Gierlotka

et al. 2024

Polish Heart J

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Andexanet alfa (AA) is a recombinant inactive analog of human activated factor X (FXa), effectively reversing the effects of its inhibitors -rivaroxaban and apixaban, which are available in Poland. The drug was approved for clinical use registration after the publication of the results of the AN-NEXA-4 trial (Andexanet Alfa, a Novel Antidote to the Anticoagulation Effects of FXa Inhibitors 4), in which its efficacy in restoring hemostasis in life-threatening hemorrhages in patients receiving using the aforementioned anticoagulants was demonstrated. Hence, AA is now recommended for patients on apixaban or rivaroxaban therapy with massive and uncontrollable hemorrhages, including hemorrhagic strokes (HS) and gastrointestinal bleeding.Drug-specific chromogenic anti-Xa assays are generally best suited for estimating rivaroxaban and apixaban plasma levels, aside from direct assessment of their concentrations. The absence of anti-Xa activity, determined using these assays, allows us to rule out the presence of clinically relevant plasma concentrations of any FXa inhibitor. On the other hand, the dose of AA should not be modified based on the results of coagulation tests, as it depends solely on the time that elapsed since the last dose of FXa inhibitor and oon the dose and type of FXa inhibitor.

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Rules for using reduced doses of non-vitamin K antagonist oral anticoagulants in the prevention of thromboembolic complications in patients with atrial fibrillation. The expert opinion of the Working Group on Cardiovascular Pharmacotherapy of the Polish Cardiac Society

Cited by 2 publications

References 18 publications

Low bleeding acceptance is associated with increased death risk in patients with atrial fibrillation on oral anticoagulation

Low bleeding acceptance is associated with increased death risk in patients with atrial fibrillation on oral anticoagulation

The use of andexanet alpha in the Polish setting: An interdisciplinary protocol. Expert consensus statement of the Polish Cardiac Society

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