The 2018 European Heart Rhythm Association Practical Guide on the use of non-vitamin K antagonist oral anticoagulants in patients with atrial fibrillation: executive summary

Steffel, Jan; Verhamme, Peter; Potpara, Tatjana; Albaladéjo, Pierre; Antz, Matthias; Desteghe, Lien; Hæusler, Karl Georg; Oldgren, Jonas; Reinecke, Holger; Roldán, Vanessa; Rowell, Nigel; Sinnaeve, Peter; Collins, Rónán; Camm, A. John; Heidbüchel, Hein

doi:10.5603/kp.2018.0180

Cited by 143 publications

(225 citation statements)

References 128 publications

(143 reference statements)

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“…The majority of the bleeding episodes were minor “nuisance” bleeds, with only 6% of DOAC patients developing a CRNMB in the 7 days following dental extractions. Therefore, timing dental extractions to avoid peak concentrations or targeting trough concentrations is unlikely to provide any additional clinical benefit. Omitting DOAC doses places the patient at undue risk for thromboembolism, yet upon DOAC recommencement, the patient will again be at risk of bleeding.…”

Section: Resultsmentioning

confidence: 99%

Dental extractions on direct oral anticoagulants vs. warfarin: The DENTST study

Brennan

Schifter

et al. 2020

Research and Practice in Thrombosis and Haemostasis

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Background Conflicting recommendations exist addressing the management of direct oral anticoagulants (DOACs) for invasive dental procedures. Objectives To determine the safety of DOAC continuation compared to warfarin continuation for dental extractions with regards to bleeding outcomes. Methods A single‐center, prospective, cohort study was performed to compare 7‐day bleeding outcomes between patients who continued their DOAC, and patients on warfarin with an International Normalized Ratio (INR) between 2.0 and 4.0. Blood tests including oral anticoagulant drug levels were measured immediately prior to extraction. The gauze used to apply pressure to the socket was weighed before and after extraction to estimate blood loss. Patients were contacted by phone 2 and 7 days after extraction. Results Eighty‐six patients on a DOAC had a total of 145 teeth extracted, and 21 patients on warfarin had 50 teeth extracted. There were no major bleeding events. The rate of minor plus clinically relevant nonmajor bleeding was comparable between the DOAC and warfarin cohorts (36% and 43%, respectively; odds ratio, 0.75; 95% confidence interval, 0.29‐1.98). Preextraction apixaban and dabigatran levels were comparable between bleeders and nonbleeders, while rivaroxaban levels were higher in those who bled. The weight change of gauze used to tamponade the socket was similar between the 2 cohorts. Conclusion Dental extractions on patients continuing DOACs led to bleeding rates similar to patients on warfarin with an INR between 2.0 and 4.0. There is no need to adjust DOAC dosing prior to dental extractions.

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Section: Resultsmentioning

confidence: 99%

Dental extractions on direct oral anticoagulants vs. warfarin: The DENTST study

Brennan

Schifter

et al. 2020

Research and Practice in Thrombosis and Haemostasis

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“…DOACs have been integrated into practice in recent years. This is reflected by updated guidelines on the treatment of AF with subsequent increases in the overall uptake of OAC . DOACs offer an alternative to warfarin in the setting of AF and VTE with a requirement for less intensive monitoring due to their pharmacological profiles.…”

Section: Introductionmentioning

confidence: 99%

Direct oral anticoagulants uptake and an oral anticoagulation paradox

Kennedy

Choitir

Clarke

et al. 2020

Brit J Clinical Pharma

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Oral anticoagulation (OAC) for stroke prevention in patients with atrial fibrillation is underutilised. One of the impediments to warfarin therapy is the frequent monitoring required, usually at a specialised warfarin clinic. The advent of direct oral anticoagulants (DOACs) facilitates OAC therapy without an onerous monitoring regimen. This benefit may result in the more significant adoption of DOACs in areas without a warfarin clinic. This study analysed national administrative data for reimbursed pharmacy claims to assess OAC prescribing from 2010 to 2017 and compared the use of DOACs in areas with warfarin clinics compared to those without. Over the study period, the number of patients on OAC increased by 84%, due to a rapid increase in DOAC prescribing. The findings demonstrate that DOACs have resulted in an increase in the overall uptake of OAC therapy in Ireland. However, the increased utilisation was not evidently related to populations underserved by warfarin clinics.

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“…Regarding DOACs, the doses approved for stroke prevention should be used. Data on concomitant use of prasugrel or ticagrelor in patients taking OACs are scarce, and the risk of bleeding with either of these drugs may be excessive in combination with aspirin in anticoagulated patients . Hence, clopidogrel is the preferred antiplatelet agent regarding PCI in patients with indications for OACs .…”

Section: Bleeding Prevention and Bleeding Reduction Strategiesmentioning

confidence: 99%

“…Hence, clopidogrel is the preferred antiplatelet agent regarding PCI in patients with indications for OACs . Importantly, new‐generation drug‐eluting stents and radial approach should be used to minimize bleeding risk, while proton pump inhibitors should be considered in all patients receiving TT to minimize gastrointestinal bleeding . Concomitant use of nonsteroidal anti‐inflammatory drugs should be avoided in patients with AF and ACS (Figure ) …”

Section: Bleeding Prevention and Bleeding Reduction Strategiesmentioning

confidence: 99%

Triple therapy in patients with atrial fibrillation and acute coronary syndrome or percutaneous coronary intervention/stenting

Kozieł

Potpara

Lip

2020

Research and Practice in Thrombosis and Haemostasis

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Patients with atrial fibrillation (AF) and acute coronary syndrome (ACS) are at high risk of stroke, recurrent coronary ischemic events, and cardiovascular mortality. The composition of antithrombotic therapy including an oral anticoagulant and antiplatelet drug(s) should be tailored according to the individual patient’s risk profile, to reduce the bleeding risk and maintain antithrombotic effect. There is no single antithrombotic treatment regimen that would fit to all patients with AF and ACS. However, available data promote the use of full‐dose direct oral anticoagulants (DOACs) (dabigatran 150 mg twice daily or apixaban 5 mg twice daily) or rivaroxaban 15 mg once daily in patients with AF and ACS or percutaneous coronary intervention (PCI). For many patients, a DOAC plus P2Y12 inhibitor early after ACS and/or PCI would be optimal, whereas a longer course of triple therapy should be used in patients at high thrombotic risk.

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The 2018 European Heart Rhythm Association Practical Guide on the use of non-vitamin K antagonist oral anticoagulants in patients with atrial fibrillation: executive summary

Cited by 143 publications

References 128 publications

Dental extractions on direct oral anticoagulants vs. warfarin: The DENTST study

Dental extractions on direct oral anticoagulants vs. warfarin: The DENTST study

Direct oral anticoagulants uptake and an oral anticoagulation paradox

Triple therapy in patients with atrial fibrillation and acute coronary syndrome or percutaneous coronary intervention/stenting

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