New oral anticoagulants in our clinical practice

  • B. B
  • B. M
  • L. L
  • et al.
ISSN: 0049-3848
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Abstract

Background: Vitamin K antagonists (VKAs) have been the standard of care for stroke prevention in patients with atrial fibrillation (AF) since the early 1990s. Within the past year and a half new oral anticoagulants (NOACs) were approved on the market in Slovenia for prevention of stroke and systemic embolism in patients with nonvalvular AF. Since then 490 patients with AF were treated in our outpatient clinic for diagnostics and treatment of coagulopathy. Purpose of this paper is to review the results of our thromboprophylaxis in these patients. Methods: VKA are very effective but are limited by factors such as drug to drug interactions, food interactions, slow onset and offset of action, haemorrhage and need for routine anticoagulation monitoring to maintain a therapeutic international normalised ratio (INR). In the last three years computer-based clinical decision support system (named TROMBO) was used in our clinic to support our management and dosing of VKA therapy. Data of patients treated with NOACs were also included in the updated TROMBO in order to improve therapy and facilitate statistical analysis. Results: There were 2305 patients with AF registered in TROMBO. More than 1392 (67%) of the patients were over 80 years of age. 1815 (79%) of the patients with VKA were treated, 307 (13%) with dabigatran and 183 (8%) with rivaroxaban. In average of 61.4% of the time the INR values were within therapeutic range. Patients had low-moderate risk of stroke, with CHADS2 score of 2.1. 64 (1.9%) minor bleeding and 16 (0.4%) major bleeding were registered on the base of VKA, where else 5 (1.6%) minor bleeding and 1 (0.3%) major bleeding were found in patients using dabigatran and 6 (2.1%) minor bleeding and 2 (0.7%) major bleeding in patients using rivaroksaban. Of all the patients 4 (0.17%) patients with stroke or TIA with VKA and 1 (0.2%) patient using dabigatran were registered. Conclusions: Clinically relevant bleeding was similar between the VKA and NOACs (2.3% versus 2.3%). Rates of strokes or TIA were 0.17% per year for VKA and 0.2% for NOACs. Our results showed the 3 agents to be associated with similar rates of stroke/TIA and bleeding.

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B., B., B., M. V., L., L., & T., B. (2014). New oral anticoagulants in our clinical practice. Thrombosis Research, 133, S44–S45. Retrieved from http://www.embase.com/search/results?subaction=viewrecord&from=export&id=L71521888

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