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Published on: February 28, 2012
Novel anticoagulants for stroke prevention in atrial fibrillation: safety issues in the elderly
Anton Strunets1, Mahek Mirza, Jasbir Sra
1Center for Integrative Research on Cardiovascular Aging (CIRCA), Aurora University of Wisconsin Medical Group, Aurora Health Care, 3033 South 27th Street, Milwaukee, WI, USA.
Insights
Novel anticoagulants offer advantages over Vitamin K antagonists for atrial fibrillation patients, particularly the elderly. Further research is needed to confirm their long-term safety and efficacy in older populations.
Area of Science:
- Pharmacology
- Geriatrics
- Cardiology
Background:
- Vitamin K antagonists (VKAs) are standard anticoagulants for atrial fibrillation (AF) stroke prevention.
- Novel oral anticoagulants (NOACs) offer alternatives with fewer food-drug interactions.
- Atrial fibrillation predominantly affects aging populations, necessitating age-specific safety and efficacy data.
Purpose of the Study:
- To review age-related pharmacokinetic and pharmacodynamic changes.
- To assess the impact of aging on NOACs.
- To evaluate drug/food interactions and bleeding risks associated with NOACs in the elderly.
Main Methods:
- Literature review of age-related changes in drug metabolism and response.
- Analysis of existing clinical trial data for NOACs in elderly populations.
- Examination of reported food-drug interactions and bleeding complications.
Main Results:
- NOACs demonstrate advantages over VKAs in studied age groups.
- Limited data exists for NOACs in the "older-elderly" (e.g., >85 years).
- Age-related changes may influence NOAC efficacy and safety, requiring careful monitoring.
Conclusions:
- NOACs present a promising alternative for anticoagulation in elderly AF patients.
- More post-marketing surveillance and research are crucial for the "older-elderly" population.
- Understanding age-specific factors is vital for optimizing anticoagulation therapy.
Abstract:
Vitamin K antagonists (VKAs) are the most widely used anticoagulants for stroke prevention in patients with atrial fibrillation (AF). Recently, the US FDA approved three novel anticoagulants that work through inhibition of coagulation cascade independent of Vitamin K-dependent enzymatic reactions and, therefore, should have less food-drug interactions. Since AF is a disease of the aging heart, it is important to assess safety and efficacy of these new anticoagulants in elderly patients. We reviewed age-related changes in pharmacokinetics and pharmacodynamics observed with senescence and the effects of these changes on novel anticoagulants, known and anticipated drug and food interactions, and challenges related to bleeding complications and temporary discontinuation prior to surgery or interventional procedure. Although advantageous to VKA in age groups represented in trials, there are lack of data on VKA usage in older-elderly patients; additional research and post-marketing analysis in older-elderly patients are needed.
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