The periprocedural management of novel oral anticoagulants in patients with nonvalvular atrial fibrillation: Rationale and a summary of the available evidence from phase 3 clinical trials

Krishnamoorthy, Arun; Sherwood, Matthew W.; Lópes, Renato D.; Becker, Richard C.

doi:10.1016/j.ahj.2014.12.008

Cited by 8 publications

(8 citation statements)

References 38 publications

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“…There is an ongoing debate in the literature regarding DOAC laboratory testing. Some authors argue that specific tests should be recommended for DOAC measurements, highlighting the inappropriateness of PT or APTT , whereas others suggest that PT or APTT should be used, if not to quantify DOACs, at least to assess for the presence/absence of drug and the anticoagulant activity .…”

Section: Discussionmentioning

confidence: 99%

Poor comparability of coagulation screening test with specific measurement in patients receiving direct oral anticoagulants: results from a multicenter/multiplatform study

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Legnani

Tripodi

et al. 2016

Journal of Thrombosis and Haemostasis

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Background Prothrombin time (PT) and activated partial thromboplastin time (APTT) have been proposed to measure the effect of oral anti-activated factor X (FXa) or anti-activated FII drugs, respectively. Aims To evaluate the relationships and responsiveness of PT and APTT versus direct oral anticoagulant (DOAC) concentrations measured with specific coagulation tests performed with different platforms in four Italian anticoagulation clinics. Methods Six hundred and thirty-five patients with atrial fibrillation participated in the study: 240 were receiving dabigatran, 264 were receiving rivaroxaban, and 131 were receiving apixaban. Blood was taken at trough and peak within the first month (15-25 days) of treatment. PT, APTT, diluted thrombin time (dTT) calibrated for dabigatran and anti-FXa calibrated for rivaroxaban or apixaban were determined. Results For dabigatran, the correlation between APTT and dTT ranged from r = 0.80 to r = 0.62. For rivaroxaban, the correlation between the anti-FXa assay and PT ranged from r = 0.91 to r = 0.73. For apixaban, the correlation between the anti-FXa assay and PT was lower than for the two other drugs (r = 0.81 to r = 0.54). Despite the above significant correlations, the responsiveness of PT or APTT was relatively poor. A discrepancy between global testing and DOAC plasma concentrations was shown in a considerable proportion of patients, depending on the platform and drug, with values ranging from 6% to 62%. Conclusions Overall, poor responsiveness of the screening tests to DOAC concentrations was observed. PT and APTT normal values cannot exclude DOAC anticoagulant activity, and PT or APTT prolongation is not always associated with DOAC anticoagulant effect as determined with specific tests.

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Section: Discussionmentioning

confidence: 99%

Poor comparability of coagulation screening test with specific measurement in patients receiving direct oral anticoagulants: results from a multicenter/multiplatform study

Testa

Legnani

Tripodi

et al. 2016

Journal of Thrombosis and Haemostasis

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“…Regarding the use of VKA, whether to interrupt anticoagulation and for how long should weigh the risk of bleeding with the risk of thrombotic complications. [9][10][11] Low-risk procedures (e.g., minor dental, dermatologic, ophthalmologic) do not routinely require interruption of anticoagulation. The procedure should be timed for the next dosing interval when drug concentration should be at its trough.…”

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confidence: 99%

“…For dabigatran and apixaban, anticoagulation should be held for at least 24 hours prior to moderate-risk procedures and 48 hours prior to high-risk procedures. 10,11 Renal impairment delays clearance of NOACs, which can require a longer interruption of anticoagulation prior to procedures. Dabigatran is most affected because it is most dependent on renal excretion and also has the longest halflife.…”

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confidence: 99%

“…For rivaroxaban, apixaban, and edoxaban, patients with creatinine clearance less than 50 mL/minute should stop anticoagulation at least 2 to 3 days prior to moderate-or high-risk procedures. 10,11 The short time to achieve steady state and rapid clearance of NOACs make bridging anticoagulation with LMWH unnecessary under most circumstances. 10 Bridging is mainly considered when interruption of anticoagulation is expected to be longer than 96 hours and in patients with a high risk of thrombotic complications.…”

mentioning

confidence: 99%

“…10,11 The short time to achieve steady state and rapid clearance of NOACs make bridging anticoagulation with LMWH unnecessary under most circumstances. 10 Bridging is mainly considered when interruption of anticoagulation is expected to be longer than 96 hours and in patients with a high risk of thrombotic complications. Use of either LMWH or unfractionated heparin may be needed in patients with renal or hepatic impairment on an agent with a longer half-life such as dabigatran, which could require cessation of the drug 5 days prior to a higher-risk procedure such as an abdominal surgery.…”

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confidence: 99%

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Update on Anticoagulation: What the Interventional Radiologist Needs to Know

Kamath

McMahon

2016

Semin intervent Radiol

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The novel oral anticoagulants (NOACs) represent a major advance in the treatment of patients with nonvalvular atrial fibrillation and venous thromboembolism (VTE). They have several advantages over vitamin-K antagonists such as warfarin, including more predictable pharmacokinetics and improved safety, particularly with fatal bleeding and intracranial hemorrhage. However, several issues remain surrounding the use of NOACs in certain subpopulations and with the approach to reversal. The periprocedural management of anticoagulation with these relatively new agents can also present several challenges. This article reviews the basic pharmacology, efficacy, and safety of these drugs. Several populations at higher risk for complications with use of NOACs are discussed, including those undergoing procedures. Finally, several target-specific reversal agents have either received FDA approval or likely will be approved in the near future; these agents and their roles in the approach to anticoagulation reversal will also be discussed.

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Antiplatelet and Anticoagulant Agents

Ibrahim

Rice

2021

Management of Bleeding Patients

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The periprocedural management of novel oral anticoagulants in patients with nonvalvular atrial fibrillation: Rationale and a summary of the available evidence from phase 3 clinical trials

Cited by 8 publications

References 38 publications

Poor comparability of coagulation screening test with specific measurement in patients receiving direct oral anticoagulants: results from a multicenter/multiplatform study

Poor comparability of coagulation screening test with specific measurement in patients receiving direct oral anticoagulants: results from a multicenter/multiplatform study

Update on Anticoagulation: What the Interventional Radiologist Needs to Know

Antiplatelet and Anticoagulant Agents

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