Oral anticoagulant use in cardiovascular disorders: a perspective on present and potential indications for
1a Cardiovascular and Cell Sciences Research Institute , St George's, University of London and Imperial College , London , UK.
Background:
Four non-vitamin-K-antagonist oral anticoagulants (NOACs) have been approved for use in various cardiovascular indications. The direct thrombin inhibitor dabigatran and the direct factor Xa inhibitors apixaban, edoxaban and rivaroxaban are now increasingly used in clinical practice. For some of these agents, available data from real-world studies support the efficacy and safety data in phase III clinical trials.
Objectives:
This review aims to summarize the current status of trials and observational studies of oral anticoagulant use over the spectrum of cardiovascular disorders (excluding venous thrombosis), provide a reference source beyond stroke prevention for atrial fibrillation (AF) and examine the potential for novel applications in the cardiovascular field.
Methods:
We searched the recent literature for data on completed and upcoming trials of oral anticoagulants with a particular focus on rivaroxaban.
Results:
Recent data in specific patient subgroups, such as patients with AF undergoing catheter ablation or cardioversion, have led to an extended approval for rivaroxaban, whereas the other NOACs have ongoing or recently completed trials in this setting. However, there are unmet medical needs for several arterial thromboembolic-related conditions, including patients with: AF and acute coronary syndrome, AF and coronary artery disease undergoing elective percutaneous coronary intervention, coronary artery disease and peripheral artery disease, implanted cardiac devices, and embolic stroke of unknown source.
Conclusion:
NOACs may provide alternative treatment options in areas of unmet need, and numerous studies are underway to assess their benefit-risk profiles in these settings.
Insights
Non-vitamin-K-antagonist oral anticoagulants (NOACs) are increasingly used for cardiovascular conditions. Ongoing research explores their use in areas with unmet medical needs, offering potential new treatment options.
Area of Science:
- Cardiology
- Pharmacology
- Thrombosis Research
Background:
- Four non-vitamin-K-antagonist oral anticoagulants (NOACs) are approved for cardiovascular indications.
- Direct thrombin and factor Xa inhibitors like dabigatran, apixaban, edoxaban, and rivaroxaban are gaining clinical use.
- Real-world data increasingly support the efficacy and safety of NOACs observed in clinical trials.
Purpose of the Study:
- To review current trials and observational studies on oral anticoagulant use in cardiovascular disorders.
- To serve as a reference for oral anticoagulant use beyond stroke prevention in atrial fibrillation (AF).
- To explore potential novel applications of oral anticoagulants in the cardiovascular field.
Main Methods:
- Literature search focused on completed and upcoming trials of oral anticoagulants.
- Particular emphasis was placed on rivaroxaban data.
- Review of observational studies and real-world data.
Main Results:
- Rivaroxaban has gained extended approval for specific patient subgroups, such as those with AF undergoing catheter ablation or cardioversion.
- Other NOACs have ongoing or completed trials in similar settings.
- Significant unmet medical needs exist for arterial thromboembolic conditions, including AF with acute coronary syndrome, coronary artery disease, peripheral artery disease, and embolic stroke of unknown source.
Conclusions:
- NOACs present potential alternative treatments for conditions with unmet medical needs.
- Numerous studies are in progress to evaluate the benefit-risk profiles of NOACs in these new settings.
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