![]() ![]() The use of DOACs is increasing in the UK. Observational data in the UK have shown the standardised risk rate for major bleeding per 1,000 person-years is 21.8 for dabigatran, 26.5 for rivaroxaban and 15.4 for apixaban. In patients with VTE, after the first three months, bleeding rates per 100 patient-years for major bleeding are 2.7 and for ICH 0.65. 7 The risk of major bleeding with oral anticoagulants in patients with VTE is 2% to 3% per year. These data showed a range for major bleeding of 1.6–3.6 versus 3.1–3.6 major plus clinically relevant non-major bleeding 4.1–20.1 versus 3.0–20.3 intracranial haemorrhage (ICH) 0.2–0.5 versus 0.7–0.9 and major gastrointestinal (GI) bleeding 0.8–3.2 versus 0.9–2.2. The risk of bleeding with DOACs in patients with AF (rates per 100 patient-years) versus vitamin K antagonists were compared in separate studies. Bleeding incidence and mortality in trials and observational data The bleeding incidence varies according to the severity of bleeding (major, clinically relevant non-major or minor bleeding), the type of DOAC, the indication, and individual risk factors. Superior safety outcomes were demonstrated in the DOAC versus vitamin K antagonist phase III trials in patients with non-valvular AF and VTE. 6 Bleeding – incidence and risk factorsīleeding is the primary risk with any anticoagulant therapy, but compared with traditional vitamin K antagonists (such as warfarin), the risk is generally thought to be lower with DOACs due to their shorter half-lives (ranging from 5 to 17 hours), more predictable pharmacokinetics, and reduced food/drug interactions. ![]() 5 Furthermore, DOACs are utilised in specific settings for prophylaxis during periods of particularly high risk, such as following orthopaedic surgery. Similarly, for suspected venous thromboembolism (VTE), DOACs are initiated while awaiting a confirmatory scan, in preference to low-molecular-weight heparin, in the absence of any contraindication, and are the agent of choice for a confirmed VTE, including in cancer patients. 4 A vitamin K antagonist is advised if a DOAC is contraindicated or not tolerated, and, for those established on warfarin, a transition to a DOAC should be offered. National Institute for Health and Care Excellence (NICE) guidance recommends DOACs (apixaban, edoxaban, rivaroxaban and dabigatran) for AF with a CHA 2DS 2-VASC score ≥2 and to consider anticoagulation with a score of 1. 1-3ĭOACs can be subclassified as inhibitors of clotting factor Xa (FXa) such as rivaroxaban, apixaban and edoxaban, and inhibitors of clotting factor IIa (FIIa) such as dabigatran etexilate. Direct oral anticoagulants (DOACs), also known as NOACs (non-vitamin K antagonist oral anticoagulants), have shown superior efficacy, safety, adherence and tolerability over traditional anticoagulants, such as vitamin K antagonists and low-molecular weight heparins, and this has resulted in a paradigm shift with DOACs as the preferred options for most patients with thrombotic disorders. atrial fibrillation (AF), valvular heart disease, congenital heart disease, and other indications. IntroductionĪnticoagulation is utilised in the management of venous thromboembolism and to prevent thrombotic complications in patients with cardiac comorbidities, e.g. We discuss their indications for use, dosing, and potential side effects. This review provides guidance relating to specific direct oral anticoagulant (DOAC) reversal agents, the antidotes. Bleeding, depending on the severity, is managed in various ways, and for severe or life-threatening bleeding, specific antidotes are indicated and recommended. Bleeding is the commonest and most concerning adverse event associated with anticoagulants. ![]()
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |