Recommendations for antithrombotic agents for the prevention of stroke and systemic embolism in patients with atrial fibrillation
At that time, apixaban was not approved for use in Canada, and was therefore not included in the Canadian Drug Expert Committee (CDEC) recommendation; in addition, antiplatelet drugs were not included. The current review was undertaken to allow the development of recommendations that include all the...
| Corporate Author: | |
|---|---|
| Format: | eBook |
| Language: | English |
| Published: |
Ottawa (ON)
Canadian Agency for Drugs and Technologies in Health
March 2013, 2013
|
| Series: | CADTH therapeutic review recommendations
|
| Subjects: | |
| Online Access: | |
| Collection: | National Center for Biotechnology Information - Collection details see MPG.ReNa |
| Summary: | At that time, apixaban was not approved for use in Canada, and was therefore not included in the Canadian Drug Expert Committee (CDEC) recommendation; in addition, antiplatelet drugs were not included. The current review was undertaken to allow the development of recommendations that include all the NOACs as well as the antiplatelet agents, acetylsalicylic acid (ASA) and clopidogrel Atrial fibrillation (AF) is a common cardiac arrhythmia associated with increased morbidity and mortality. Patients with AF are at risk of stroke and systemic embolism (SSE), 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. The risk of stroke varies considerably across patients; therefore, major guidelines recommend antithrombotic therapy based on risk assessment, quantified using a validated tool such as the CHADS2 score. 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 a frequent cause of drug-related emergency hospitalization in the elderly. New oral anticoagulants (NOACs) may feature more predictable pharmacokinetics and dosing, but there is less clinical experience outside of randomized controlled trials (RCTs) with these drugs at the moment. These NOACs include the direct thrombin inhibitor, dabigatran, and the direct factor Xa inhibitors, rivaroxaban and apixaban, which have been approved for use for the prevention of SSE in patients with AF. However, uncertainty remains regarding whether these agents show increased real-world benefits compared with warfarin. Although considered less effective at stroke prevention than anticoagulant therapy, antiplatelet agents may nevertheless be an option for selected patients. The Canadian Agency for Drugs and Technologies in Health (CADTH) previously reviewed the clinical effectiveness and cost-effectiveness of the NOACs compared with warfarin. |
|---|---|
| Physical Description: | 1 PDF file (ii, 16 pages) |