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Non-vitamin K antagonist oral anticoagulants for stroke prevention in atrial fibrillation: safety issues in the elderly
- Source :
- Expert review of clinical pharmacology. 13(12)
- Publication Year :
- 2020
-
Abstract
- Non-vitamin K antagonist oral anticoagulants (NOACs) are increasingly used for stroke prevention in patients with atrial fibrillation (AF). Since NOACs are predominantly used in the elderly with AF at high risk for stroke and bleeding and with comorbidities requiring polypharmacy, it is important to assess their safety and efficacy in this population.We review changes in pharmacokinetics and pharmacodynamics observed with senescence and the effect on NOACs and drug and food interactions. We also provide an update on challenges related to NOAC use in situations that increases the risk for bleeding or require temporary discontinuation and address practical issues in the elderly AF patients managed on NOACs. Clinical studies and trials with cardiovascular outcomes reported from January 1990 to August 2020 were identified through the Medline database using PubMed, Cochrane Library, and EMBASE database.NOACs are highly effective in preventing stroke in AF patients with non-inferior or superior efficacy to warfarin, with reduced risk of major bleeding. However, in the older-elderly, evidence comes mainly from observational studies or extrapolation from studies in populations with minimal functional limitations or comorbidities. The high upfront cost and out-of-pocket expense for copayment or deductibles also limit the use of this effective therapy in a substantial number of patients. The cost reduction may further improve long-term use for NOACs in stroke prevention in elderly patients with AF.
- Subjects :
- medicine.medical_specialty
medicine.drug_class
Administration, Oral
Hemorrhage
030226 pharmacology & pharmacy
Drug Costs
Dabigatran
03 medical and health sciences
chemistry.chemical_compound
0302 clinical medicine
Edoxaban
Internal medicine
Atrial Fibrillation
medicine
Humans
Pharmacology (medical)
cardiovascular diseases
General Pharmacology, Toxicology and Pharmaceutics
Stroke
Aged
Rivaroxaban
business.industry
Warfarin
Anticoagulants
Atrial fibrillation
General Medicine
Vitamin K antagonist
medicine.disease
chemistry
030220 oncology & carcinogenesis
Cardiology
Apixaban
business
medicine.drug
Subjects
Details
- ISSN :
- 17512441
- Volume :
- 13
- Issue :
- 12
- Database :
- OpenAIRE
- Journal :
- Expert review of clinical pharmacology
- Accession number :
- edsair.doi.dedup.....14b50233a8daa3bb3e9d7284db434a18