State of play and future direction with NOACs: An expert consensus

Abstract

Atrial fibrillation (AF) and venous thromboembolism (VTE) are cardiovascular conditions significant in contemporary practice. In both, the use of anticoagulation with vitamin K antagonists (VKAs) has been traditionally used to prevent adverse events. However, VKA therapy is associated with challenges relating to dose maintenance, the need to monitor anticoagulation, and bleeding risks. The non-vitamin K oral anticoagulants (NOACs) are becoming accepted as a clear alternative to VKA therapy for both AF and VTE management. The aim of this paper was to review contemporary evidence on the safety of NOACs in both conditions. A comprehensive literature review was conducted to explore key safety issues and expert consensus was achieved from eight professionals specialised in AF and VTE care. Consensus-based statements were formulated where available evidence was weak or contradictory. The expert statements in this paper form a key overview of the safety of NOACs compared with VKA therapy, and the comparative safety of different NOACs. It is apparent that a detailed patient work-up is required in order to identify and manage individual risk factors for bleeding and thrombosis prior to NOAC therapy. Additional measures, such as dose reductions, may also be used to maintain the safety of NOACs in practice.

Effects of Oral Anticoagulant Therapy on Gene Expression in Crosstalk between Osteogenic Progenitor Cells and Endothelial Cells

“…DOACs are often referred to as non-vitamin K oral anti-coagulants (NOACs) to emphasize their distinction from vitamin K antagonists (VKAs), whose main exponent is warfarin. The VKA mechanism of action in the coagulation cascade is based on antagonizing vitamin K, an essential cofactor for γ-carboxylation of factors II, VII, IX, and X [2].…”

“…DOACs are indicated for the prevention and treatment of recurrent venous thromboembolism (VTE) and for the prevention of stroke and systemic embolization in patients with non-valvular atrial fibrillation (NVAF). Patients who underwent mechanical valve prostheses or suffered from moderate to severe mitral stenosis are excluded from the treatment [2,3]. Thromboembolic disease can occur both in the arterial and the venous system with different characteristics in terms of the determining factors, thrombus morphology, and associated diseases.…”

The Combination of Oral Anticoagulant and Antiplatelet Therapies: Stay One Step Ahead

“…The advent of direct oral anticoagulants (DOACs) has revolutionized the therapy of nonvalvular atrial fibrillation (NVAF) and the therapy of VTE. 1 On the other hand, to date, the optimal treatment of ischemic artery diseases is antiplatelet therapy: single antiplatelet therapy for secondary prevention of stable coronary artery disease (CAD) and dual antiplatelet therapy (DAPT), with aspirin and an inhibitor of the platelet P2Y12 receptor, for the treatment of patients with ACS and those undergoing PCI. 2 The combination of oral anticoagulant (OAC) and antiplatelet therapy is required in many conditions of great clinical impact.…”

The Changing Face of Venous Thromboembolism Management in England

“…These data clearly show NOACs unseating warfarin as the standard of care for VTE in 2016, with changes in the individual NOACs reflecting licensing and market availability. The attitudes and prescribing characteristics of the physician are significant factors in determining the uptake of new agents in clinical practice [7]. Individual physicians may be reluctant to prescribe NOACs in preference to VKA therapy due to their own long-standing history of VKA prescribing and the perceived concerns regarding safety and benefits of NOACs [7].…”

“…The attitudes and prescribing characteristics of the physician are significant factors in determining the uptake of new agents in clinical practice [7]. Individual physicians may be reluctant to prescribe NOACs in preference to VKA therapy due to their own long-standing history of VKA prescribing and the perceived concerns regarding safety and benefits of NOACs [7]. However, in this analysis, it is clear that physicians have become increasingly comfortable, over a short period of time, in using NOACs for the treatment of VTE without cancer.…”