Antithrombotic agents for the prevention of stroke and systemic embolism in patients with atrial fibrillation

There are decades of experience with the use of the vitamin K antagonist (VKA) warfarin, as well as compelling evidence of efficacy with regard to stroke prevention. However, individualized dose adjustments and laboratory monitoring are required, and warfarin remains the most common cause of drug-re...

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Corporate Author: Canadian Agency for Drugs and Technologies in Health
Format: eBook
Language:English
Published: Ottawa (ON) Canadian Agency for Drugs and Technologies in Health [2013], 2013
Series:CADTH therapeutic review
Subjects:
Online Access:
Collection: National Center for Biotechnology Information - Collection details see MPG.ReNa
Summary:There are decades of experience with the use of the vitamin K antagonist (VKA) warfarin, as well as compelling evidence of efficacy with regard to stroke prevention. However, individualized dose adjustments and laboratory monitoring are required, and warfarin remains the most common cause of drug-related emergency hospitalization in the elderly. Because there is less clinical experience with the new oral anticoagulant (NOAC) drugs apixaban, dabigatran, and rivaroxaban outside of randomized controlled trials, it is not yet clear whether the NOACs show increased real-world benefits compared with warfarin. Although less effective at stroke prevention than anticoagulant therapy in most risk categories, antiplatelet agents may still be the best choice for selected patients.
Atrial fibrillation (AF) is a common cardiac arrhythmia associated with increased morbidity and mortality. Patients with AF are at increased risk of systemic embolism (SE) and stroke, which can cause death, disability, and impaired quality of life. Antithrombotic therapies, such as oral anticoagulant and antiplatelet drugs, can reduce the risk for stroke and systemic thromboembolism and are recommended for most AF patients with risk factors for stroke. Antithrombotic therapies are also associated with a risk of bleeding, and their efficacy for stroke prevention should always be balanced against a patient's risk of hemorrhage. Existing guidelines recommend antithrombotic therapy based on risk of stroke, and most patients with non-valvular AF benefit from some form of antithrombotic therapy with an anticoagulant or antiplatelet drug. However, each oral antithrombotic drug used for stroke prevention in AF has advantages and disadvantages.
Following individual recommendations for dabigatran and rivaroxaban in AF made by the Common Drug Review (CDR), the Canadian Agency for Drugs and Technologies in Health (CADTH) previously reviewed the clinical effectiveness and cost-effectiveness of the NOACs compared with warfarin for CDEC to develop recommendations for policy-makers regarding the NOACs and warfarin.18 At that time, apixaban was not approved for use in Canada, and was therefore not included in the CDEC recommendation; in addition, antiplatelet drugs were not included. The current review was undertaken to extend the previous review to allow CDEC to develop recommendations that include all the NOACs, as well as the antiplatelet drugs acetylsalicylic acid (ASA) and clopidogrel
Item Description:Title from PDF cover. - "March 2013."
Physical Description:1 PDF file (x, 130 pages) illustrations