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Tailored Direct Oral Anticoagulation in Patients with Atrial Fibrillation: The Future of Oral Anticoagulation?

JOURNAL OF CLINICAL MEDICINE (2022)

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Summary: This study assessed the plasma levels of anti-Xa (rivaroxaban, apixaban) and anti-IIa (dabigatran) in patients with atrial fibrillation (AF) who experienced acute embolic strokes while on long-term DOAC treatment. The results showed significantly lower levels of anti-IIa and anti-Xa in AF patients with embolic stroke compared to those who tolerated long-term therapeutic dose DOAC therapy.

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Summary: This study aimed to investigate the clinical implications and prognostic value of measuring DOAC plasma levels in patients with atrial fibrillation and ischemic stroke. Monitoring DOAC plasma levels can help identify patients at increased risk of stroke recurrence, particularly those with high glomerular filtration rate.

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Trough Concentration Deficiency of Rivaroxaban in Patients With Nonvalvular Atrial Fibrillation Leading to Thromboembolism Events

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Summary: This retrospective study investigated factors affecting the steady-state trough concentrations of rivaroxaban in patients with NVAF. The study found that low albumin levels were the main contributor to C-trough deficiency. Additionally, C-trough deficiency was associated with thrombotic events but not bleeding events.

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Summary: This study investigated the pharmacokinetic correlates and outcomes in AIS patients excluded from thrombolysis due to DOAC use. The results showed that AIS patients on DOAC therapy have a higher risk of mortality. Further research is needed to examine the safety and efficacy of thrombolysis in such patients based on the time of DOAC ingestion and/or anti-Xa/drug level.

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Do Apixaban Plasma Levels Relate to Bleeding? The Clinical Outcomes and Predictive Factors for Bleeding in Patients with Non-Valvular Atrial Fibrillation

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Summary: Apixaban is effective in preventing stroke events in patients with NVAF, but the association between apixaban plasma levels and bleeding events in Asian populations is limited. This study found that bleeding events were associated with higher apixaban trough levels and bleeding history. Most patients had apixaban plasma levels within the expected range.

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The Influence of ABCB1 (rs1045642 and rs4148738) Gene Polymorphisms on Rivaroxaban Pharmacokinetics in Patients Aged 80 Years and Older with Nonvalvular Atrial Fibrillation

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The impact of ABCB1 and CES1 polymorphisms on dabigatran pharmacokinetics and pharmacodynamics in patients with atrial fibrillation

Qiuyi Ji et al.

Summary: Our study found that the minor allele(C) on CES1 SNP rs8192935 was associated with PDC and APTT values, while the minor allele(A) carriers of CES1 SNP rs2244613 exhibited higher PDC levels and increased risk for minor bleeding in NVAF patients receiving dabigatran.

BRITISH JOURNAL OF CLINICAL PHARMACOLOGY (2021)

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Apixaban and rivaroxaban in obese patients treated for venous thromboembolism: Drug levels and clinical outcomes

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Summary: This study aimed to assess DOAC concentrations in obese VTE patients and found that factors associated with concentrations outside the on-therapy ranges include age ≤63 years, use of rivaroxaban, and time since last intake ≤8 h. During follow-up, 2% of patients receiving apixaban may experience recurrent VTE, with no major bleeding and 8% experiencing minor bleeding. Overall, the risk-benefit profile of fixed-dose DOACs in obese patients appeared comparable to that in non-obese patients.

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Risk factors and one-year mortality in patients with direct oral anticoagulant-associated gastrointestinal bleeding

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Summary: This study identified risk factors for DOAC-associated gastrointestinal bleeding (GIB), including active cancer, renal impairment, bleeding predisposition, COPD, and uncontrolled hypertension. Adjusted one-year mortality was significantly higher in patients with DOAC-associated GIB compared to those without GIB.

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2021 European Heart Rhythm Association Practical Guide on the Use of Non-Vitamin K Antagonist Oral Anticoagulants in Patients with Atrial Fibrillation

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2021 Update of the International Council for Standardization in Haematology Recommendations for Laboratory Measurement of Direct Oral Anticoagulants

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Summary: The ICSH published guidance on measuring DOACs in 2018, and significant changes have occurred since then, including the approval of a new DOAC and a specific DOAC reversal agent. Additional research is needed in areas such as patient populations and point-of-care testing.

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Update on drug interactions with non-vitamin-K-antagonist oral anticoagulants for stroke prevention in elderly patients

Claudia Stoellberger et al.

Summary: This study updates the knowledge about drug-drug interactions (DDI) of non-vitamin-K-antagonist oral anticoagulants (NOAC) in patients >= 75 years since 2017. Pharmacodynamic DDI of NOAC with drugs affecting platelet function are most frequent, while pharmacokinetic DDI were found for 37 of 117 drugs. Reports about DDI of cardiovascular drugs with NOAC were the most prevalent.

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Summary: The study developed a method combining methanol protein precipitation with liquid chromatography - mass spectrometry for simultaneous separation and determination of various direct oral anticoagulants. The method has been fully validated and showed a strong correlation with coagulation assays, with successful application in post-mortem serum samples.

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Imo J. Akpan et al.

Summary: DOACs like apixaban, dabigatran, edoxaban, and rivaroxaban are commonly used for stroke prevention in non-valvular atrial fibrillation patients and for the treatment of venous thromboembolism. While routine laboratory monitoring is not required, there are special situations where laboratory assessment may be necessary.

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Anti-Xa Activity in Elderly Xabans-Treated Patients With Atrial Fibrillation

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