The role of direct oral anticoagulants in the treatment of patients with non-valvular atrial fibrillation

Authors: Gyulmamedova S.M., Bulaeva N.I., Kubova M.Ch.

Company: Bakoulev National Medical Research Center for Cardiovascular Surgery, Moscow, Russian Federation

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Type:  Reviews


DOI: https://doi.org/10.24022/1997-3187-2023-17-3-350-358

For citation: Gyulmamedova S.M., Bulaeva N.I., Kubova М.Ch. The role of direct oral anticoagulants in the treatment of patients with non-valvular atrial fibrillation. Creative Cardiology. 2023; 17 (3): 350–8 (in Russ.). DOI: 10.24022/1997-3187-2023-17-3-350-358

Received / Accepted:  21.08.2023 / 16.09.2023

Keywords: atrial fibrillation direct oral anticoagulants apixaban dabigatran rivaroxaban edoxaban

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Abstract

Atrial fibrillation (AF) is the most common type of arrhythmia. With an aging world population and changing lifestyles, the frequency of this arrhythmia is rapidly increasing. The main negative consequences of AF are thrombosis and embolism. Anticoagulant therapy acts as the basis for the treatment of patients with this type of arrhythmia, the goal of which is to prevent thrombosis, thromboembolism and death. Direct oral anticoagulants (DOACs) are a more acceptable alternative than vitamin K antagonists for stroke prevention in patients with nonvalvular AF. Despite the greater ease of use of DOACs, challenges to their actual use in clinical practice still remain, and they are not limited to financial issues. In the absence of the opportunity to obtain the results of randomized clinical trials (RCTs) with direct comparisons of these drugs in the clinical practice of a doctor, the question often arises: which DOAC is still better? This article reviews RCTs, retrospective database studies, and large-scale prospective cohort studies in recent years that highlight the effectiveness and safety of anticoagulant therapy for non-valvular AF.

References

  1. Kornej J., Börschel C.S., Benjamin E.J., Schnabel R.B. Epidemiology of atrial fibrillation in the 21st century: novel methods and new insights. Circ. Res. 2020; 127 (1): 4–20. DOI: 10.1161/CIRCRESAHA.120.316340
  2. Lippi G., Sanchis-Gomar F., Cervellin G. Global epidemiology of atrial fibrillation: an increasing epidemic and public health challenge. Int. J. Stroke. 2021; 16 (2): 217–21. DOI: 10.1177/1747493019897870
  3. Lopez-Lopez J.A., Sterne J.A.C., Thom H.H.Z., Higgins J.P.T., Hingorani A.D., Okoli G.N. et al. Oral anticoagulants for prevention of stroke in atrial fibrillation: systematic review, network meta-analysis, and cost effectiveness analysis. BMJ. 2017; 359: j5058. DOI: 10.1136/bmj.j5058
  4. Skjoth F., Larsen T.B., Rasmussen L.H., Lip G.Y.H. Efficacy and safety of edoxaban in comparison with dabigatran, rivaroxaban and apixaban for stroke prevention in atrial fibrillation. Thromb. Haemost. 2014; 111 (05): 981–8. DOI: 10.1160/TH14-02-0118
  5. Roberti R., Iannone L.F., Palleria C., Curcio A., Rossi M., Sciacqua A. et al. Direct Oral Anticoagulants: From Randomized Clinical Trials to Real-World Clinical Practice. Front. Pharmacol. 2021; 12: 684638. DOI: 10.3389/fphar.2021.684638
  6. Аракелян М.Г., Бокерия Л.А., Васильева Е.Ю., Голицын С.П., Голухова Е.З., Горев М.В. и др. Фибрилляция и трепетание предсердий. Клинические рекомендации 2020. Российский кардиологический журнал. 2021; 26 (7): 4594. DOI: 10.15829/1560-4071-2021-4594 Arakelyan M.G., Bockeria L.A., Vasilieva E.Yu., Golitsyn S.P., Golukhova E.Z., Gorev M.V. et al. 2020 Clinical guidelines for Atrial fibrillation and atrial flutter. Russian Journal of Cardiology. 2021; 26 (7): 4594 (in Russ.). DOI: 10.15829/1560-4071-2021-4594
  7. Hindricks G., Potpara T., Dagres N., Arbelo E., Bax J.J., Blomström-Lundqvist C. et al. 2020 ESC guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for CardioThoracic Surgery (EACTS): the task force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC. Eur. Heart J. 2021; 42 (5): 373–498. DOI: 10.1093/eurheartj/ehaa612
  8. January C.T., Wann L.S., Calkins H., Chen L.Y., Cigarroa J.E., Cleveland Jr. J.C. et al. 2019 AHA/ACC/HRS focused update of the 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines and the Heart Rhythm Society in collaboration with the Society of Thoracic Surgeons. Circulation. 2019; 74 (1): 104–32. DOI: 10.1016/j.jacc.2019.01.011
  9. Brieger D., Amerena J., Attia J.R., Bajorek B., Chan K.H. , Connell C. et al. National Heart Foundation of Australia and the Cardiac Society of Australia and New Zealand: Australian clinical guidelines for the diagnosis and management of atrial fibrillation 2018. Heart Lung Circulation. 2018; 27 (10): 1209– 66. DOI: 10.1016/j.hlc.2018.06.1043
  10. Chan N., Sobieraj-Teague M., Eikelboom J.W. Direct oral anticoagulants: evidence and unresolved issues. Lancet. 2020; 396 (10264): 1767–76. DOI: 10.1016/S0140-6736(20)32439-9
  11. Joppa S., Salciccioli J., Adamski J., Patel S., Wysokinski W., McBane R. et al. A practical review of the emerging direct anticoagulants, laboratory monitoring, and reversal agents. J. Clin. Med. 2018; 7 (2): 29. DOI: 10.3390/jcm7020029
  12. Sikorska J., Uprichard J. Cardiovascular pharmacotherapy direct oral anticoagulants : a quick guide. Eur. Cardiol. 2017; 12 (1): 40–5. DOI: 10.15420/ecr.2017:11:2 13. Weitz J.I., Jaffer I.H., Fredenburgh J.C. Recent advances in the treatment of venous thromboembolism in the era of the direct oral anticoagulants. F1000Res. 2017; 6: 985. DOI: 10.12688/f1000research.11174.1
  13. Steffel J., Verhamme P., Potpara T.S., Albaladejo P., Antz M., Desteghe L. et al. The 2018 European Heart Rhythm Association practical guide on the use of non-vitamin K antagonist oral anticoagulants in patients with atrial fibrillation. Eur. Heart J. 2018; 39 (16): 1330–93. DOI: 10.1093/eurheartj/ehy136
  14. Connolly S.J., Ezekowitz M.D., Yusuf S., Eikelboom J., Oldgren J., Parekh A. et al.; RE-LY Steering Committee and Investigators. Dabigatran versus warfarin in patients with atrial fibrillation. N. Engl. J. Med. 2009; 361 (12): 1139–51. DOI: 10.1056/NEJMoa0905561
  15. Connolly S.J., Wallentin L., Ezekowitz M.D., Eikelboom J., Oldgren J., Reilly P.A. et al. The long-term multicenter observational study of dabigatran treatment in patients with atrial fibrillation (rely-able) study. Circulation. 2013; 128 (3): 237–43. DOI: 10.1161/CIRCULATIONAHA.112.001139 17. Niessner A. Rivaroxaban versus warfarin in nonvalvular atrial fibrillation. N. Engl. J. Med. 2011; 365 (10): 883–91. DOI: 10.1056/NEJMoa1009638
  16. Patel M.R., Mahaffey K.W., Garg J., Pan G., Singer D.E., Hacke W. et al.; ROCKET AF Investigators. Rivaroxaban versus warfarin in non-valvular atrial fibrillation. N. Engl. J. Med. 2011; 365 (10): 883–91. DOI: 10.1056 /NEJMoa1009638
  17. Easton J.D., Lopes R.D., Bahit M.C., Wojdyla D.M., Granger C.B., Wallentin L. et al. Apixaban compared with warfarin in patients with atrial fibrillation and previous stroke or transient ischemic attack: a subgroup analysis of the ARISTOTLE trial. Lancet Neurol. 2012; 11 (6): 503–11. DOI: 10.1016/S1474-4422(12)70092-3
  18. Granger C.B., Alexander J.H., McMurray J.J.V., Lopes R.D., Hylek E.M., Hanna M. et al. Apixaban versus warfarin in patients with atrial fibrillation. N. Engl. J. Med. 2011; 365 (11): 981–92. DOI: 10.1056/NEJMoa1107039
  19. Giugliano R.P., Ruff C.T., Braunwald E., Murphy S.A., Wiviott S.D., Halperin J.L. et al. Edoxaban versus warfarin in patients with atrial fibrillation. N. Engl. J. Med. 2013; 369 (22): 2093–104. DOI: 10.1056/NEJMoa1310907
  20. Deitelzweig S., Bergrath E., Fusco M., Kang A., Savone M., Cappelleri J.C. et al. Real-world evidence comparing oral anticoagulants in non-valvular atrial fibrillation: a systematic review and network meta-analysis. Future Cardiol. 2022; 18 (5): 393–405. DOI: 10.2217/fca-2021-0120
  21. Durand M., Schnitzer M.E., Pang M., Carney G., Eltonsy S., Filion K.B. et al. For the Canadian Network for Observational Drug Effect Studies (CNODES) Investigators. Effectiveness and safety among direct oral anticoagulants innonvalvular atrial fibrillation: a multi-database cohort studywith meta-analysis. Br. J. Clin. Pharmacol. 2021; 87 (6): 2589–601. DOI: 10.1111/bcp.14669
  22. Lopez-Lopez J.A., Sterne J.A.C., Thom H.H.Z., Higgins J.P.T., Hingorani A.D., Okoli G.N. et al. Oral anticoagulants for prevention of stroke in atrial fibrillation: systematic review, network meta-analysis, and cost effectiveness analysis. BMJ. 2017; 359: j5058. DOI: 10.1136/bmj.j5058
  23. Di Biase L., Burkhardt J.D., Santangeli P., Mohanty P., Sanchez J.E., Horton R. et al. Periprocedural stroke and bleeding complications in patients undergoing catheter ablation of atrial fibrillation with different anticoagulation management: results from the Role of Coumadin in preventing thromboembolism in atrial fibrillation (AF) patients undergoing catheter ablation (COMPARE) randomized trial. Circulation. 2014; 129 (25): 2638–44. DOI: 10.1161/CIRCULATIONAHA.113.006426
  24. Silva M.A., Futuro G.M.C., Merçon E.S., Vasconcelos D., Agrizzi R.S., Neto J.E. et al. Safety of catheter ablation of atrial fibrillation under uninterrupted rivaroxaban use. Arq. Bras. Cardiol. 2020; 114 (3):435–42. DOI: 10.36660/abc.20180386
  25. Cardoso R., Knijnik L., Bhonsale A., Miller J., Nasi G., Rivera M. et al. An updated meta-analysis of novel oral anticoagulants versus vitamin K antagonists for uninterrupted anticoagulation in atrial fibrillation catheter ablation. Heart Rhythm. 2018; 15 (1): 107–15. DOI: 10.1016/j.hrthm.2017.09.011
  26. Calkins H., Willems S., Gerstenfeld E.P., Verma A., Schilling R., Hohnloser S.H. et al. Uninterrupted dabigatran versus warfarin for ablation in atrial fibrillation. N. Engl. J. Med. 2017; 376: 1627–36. DOI: 10.1056/NEJMoa1701005
  27. Hohnloser S.H., Calkins H., Willems S., Verma A., Schilling R., Okumura K. et al. Regional differences in patient characteristics and outcomes during uninterrupted anticoagulation with dabigatran versus warfarin in catheter ablation of atrial fibrillation: the RE-CIRCUIT study. J. Interv. Card. Electrophysiol. 2019; 55: 145–52. DOI: 10.1007/s10840-019-00518-x
  28. Cappato R., Marchlinski F.E., Hohnloser S.H., Naccarelli G.V., Xiang J., Wilber D.J. et al. Uninterrupted rivaroxaban vs. uninterrupted vitamin K antagonists for catheter ablation in nonvalvular atrial fibrillation. Eur. Heart J. 2015; 36 (28): 1805–11. DOI: 10.1093/eurheartj/ehv177
  29. Kirchhof P., Haeusler K.G., Blank B., De Dono J., Callans D., Elvan A. et al. Apixaban in patients at risk of stroke undergoing atrial fibrillation ablation. Eur. Heart J. 2018; 39 (32): 2942–55. DOI: 10.1093/eurheartj/ehy176
  30. Shakhmatova O.O. The role of edoxaban in preventing thromboembolic complications in patients with atrial fibrillation. Atherothrombosis. 2020; (2): 28-43 (in Russ.). DOI: 10.21518/2307-1109-2020-2-28-43

About Authors

  • Sayali M. Gyulmamedova, Postgraduate; ORCID
  • Naida I. Bulaeva, Cand. Biol. Sci., Head of the Department, Associate Professor, Cardiologist; ORCID
  • Maida Ch. Kubova, Researcher, Cardiologist; ORCID

Chief Editor

Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, President of Bakoulev National Medical Research Center for Cardiovascular Surgery