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Oral anticoagulants in coronary heart disease (Section IV) Position paper of the ESC Working Group on Thrombosis - Task Force on Anticoagulants in Heart Disease
Univ G DAnnunzio, Chieti, Italy.;Fdn Toscana G Monasterio, Pisa, Italy..
Univ Aarhus, Aarhus, Denmark..
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology.
Univ Cattolica Sacro Cuore, I-00168 Rome, Italy..
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2016 (English)In: Thrombosis and Haemostasis, ISSN 0340-6245, Vol. 115, no 4, 685-711 p.Article in journal (Refereed) PublishedText
Abstract [en]

Until recently, vitamin K antagonists (VKAs) were the only available oral anticoagulants evaluated for long-term treatment of patients with coronary heart disease (CHD), particularly after an acute coronary syndrome (ACS). Despite efficacy in this setting, VKAs are rarely used because they are cumbersome to administer. Instead, the more readily manageable antiplatelet agents are the mainstay of prevention in ACS patients. This situation has the potential to change with the introduction of non-VKA oral anticoagulants (NOACs), which are easier to administer than VKAs because they can be given in fixed doses without routine coagulation monitoring. The NOACs include dabigatran, which inhibits thrombin, and apixaban, rivaroxaban and edoxaban, which inhibit factor Xa. Apixaban and rivaroxaban were evaluated in phase III trials for prevention of recurrent ischaemia in ACS patients, most of whom were also receiving dual antiplatelet therapy with aspirin and clopidogrel. Although at the doses tested rivaroxaban was effective and apixaban was not, both agents increased major bleeding. The role for the NOACs in ACS management, although promising, is therefore complicated, because it is uncertain how they compare with newer antiplatelet agents, such as prasugrel, ticagrelor or vorapaxar, and because their safety in combination with these other drugs is unknown. Ongoing studies are also now evaluating the use of NOACs in non-valvular atrial fibrillation patients, where their role is established, with coexistent ACS or coronary stenting. Focusing on CHD, we review the results of clinical trials with the NOACs and provide a perspective on their future incorporation into clinical practice.

Place, publisher, year, edition, pages
2016. Vol. 115, no 4, 685-711 p.
Keyword [en]
Anticoagulants, vitamin K antagonists, non-vitamin K antagonist oral anticoagulants, dabigatran etexilate, rivaroxaban, apixaban, edoxaban, coronary heart disease, acute coronary syndrome
National Category
Hematology Cardiac and Cardiovascular Systems
Identifiers
URN: urn:nbn:se:uu:diva-300322DOI: 10.1160/TH15-09-0703ISI: 000373862900001PubMedID: 26952877OAI: oai:DiVA.org:uu-300322DiVA: diva2:951258
Funder
AstraZenecaGlaxoSmithKline (GSK)
Available from: 2016-08-08 Created: 2016-08-08 Last updated: 2016-08-08Bibliographically approved

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Wallentin, LarsSiegbahn, Agneta
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