Anticoagulation Therapy New Drugs

You may have heard about new oral anticoagulants on the market that do not require monitoring.

Recent studies have found:

  • At study sites with better INR control, incidence of major bleeding was similar for dabigatran 150 mg and warfarin1
  • Consistency in maintaining INR between 2.0–3.0 with warfarin will determine whether novel oral agents confer lower bleeding risk2
  • Low bleeding risk with dabigatran/factor Xa inhibitors3 will bring greater attention to importance of INR monitoring and dose-adjustment for those receiving warfarin

Warfarin with monitoring should be the standard of care if:

  • There is a risk of non-compliance4,5,6
  • There are co-morbidities (hypertension, heart failure, diabetes)6
  • The patient has renal impairment5
  • The patient has a mechanical heart valve4
  • The patient is elderly (> 75 years)4
  • The patient has an increased risk of bleeding7
  • Cost is an issue7
  • The patients are children or adolescents7
  • The patient prefers a drug that has an antidote7
  • The patient is intolerant to the new drugs8


Expand | Collapse
References
  1. Wallentin et al (2010). Lancet 376:975-983
  2. Cannon & Stecker (2010). Am J Manag Care 16:S291-S297
  3. Connolly et al (2009). N Engl J Med 36:1139-1151
  4. Available at: http://www.ukcpa.net/wp-content/uploads/2011/08/FINAL-UKCPA-Position-statement-on-NOACs-FINAL-July2011.pdf last accessed October 2011
  5. Wann et al (2011). J Am Coll Cardiol 57:1330-1337
  6. Fuster et al (2011). Circulation 123:269-367
  7. Market research with 288 GPs and 29 experts from Australia, Germany, UK, USA; Q2 2011
  8. Connolly et al (2009). N Engl J Med 361:1139-1151