Using non-vitamin K oral anticoagulants in specific patient populations: a study of Korean cases

Il Young Cho1,2 1College of Pharmacy, Ewhawomans University, Seoul, Republic of Korea; 2Pharmaceutical Safety Bureau, Ministry of Food and Drug Safety, Cheongju-si, Republic of KoreaCorrespondence: Il Young ChoPharmaceutical Safety Bureau, Ministry of Food and Drug Safety, 187, Osongsaengmyeong 2-ro...

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Autor principal:	Cho IY
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2019
Materias:	non-valvular atrial fibrillation venous thromboembolism risk management plan optimal dose drug price cost-effectiveness Therapeutics. Pharmacology RM1-950
Acceso en línea:	https://doaj.org/article/779b82ec483243e9a690a777716fbf5c
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spelling	oai:doaj.org-article:779b82ec483243e9a690a777716fbf5c2021-12-02T11:41:58ZUsing non-vitamin K oral anticoagulants in specific patient populations: a study of Korean cases1178-203Xhttps://doaj.org/article/779b82ec483243e9a690a777716fbf5c2019-10-01T00:00:00Zhttps://www.dovepress.com/using-non-vitamin-k-oral-anticoagulants-in-specific-patient-population-peer-reviewed-article-TCRMhttps://doaj.org/toc/1178-203XIl Young Cho1,2 1College of Pharmacy, Ewhawomans University, Seoul, Republic of Korea; 2Pharmaceutical Safety Bureau, Ministry of Food and Drug Safety, Cheongju-si, Republic of KoreaCorrespondence: Il Young ChoPharmaceutical Safety Bureau, Ministry of Food and Drug Safety, 187, Osongsaengmyeong 2-ro, Osong-eup, Heungdeok-gu, Cheongju-si, Chungcheongbuk-do 28159, Republic of KoreaTel +82 43 719 2709Fax +82 43 719 2700Email iycho10@korea.krAbstract: Non-vitamin K oral anticoagulants (NOACs) are increasingly used as alternatives to conventional therapies and have considerable accumulated real-world clinical data in patients with non-valvular atrial fibrillation (NVAF) or venous thromboembolism (VTE). However, it is not easy to make a complete changeover to NOACs in real-world clinical practice because NOACs still have challenges in specific patient populations (eg, Asian patients, NVAF patients presenting with acute coronary syndrome [ACS], dialysis patients with NVAF, patients with cancer-associated VTE, etc.). Clinical data on the optimal dose of NOACs in Asian patients with NVAF are not sufficient. The intensity of NOAC and antiplatelet treatment and the duration of antiplatelet treatment should be adjusted according to the bleeding and thrombotic risk profiles of the individual NVAF patient presenting with ACS. Increased bleeding risk and unclear efficacy of NOACs in dialysis patients with NVAF should be considered when making decisions on whether to give NOACs for these patients. If dialysis patients with NVAF require anticoagulant for stroke prevention, then apixaban could be considered while awaiting more clinical efficacy and safety data. Additional studies are needed to determine the utility of continuing treatment with reduced-dose NOACs for long-term therapy after VTE. We have enough experiences in using NOACs in cancer patients showing the benefit of antithrombotic treatment counterbalanced the bleeding risk; however, some challenges of cancer-associated VTE management exist due to differences in cancer types or chemotherapy regimens and comorbidities. Different dosing regimens among NOACs may impact on medication adherence; thus, individual patient preference should be considered in choosing a particular NOAC. A significant proportion of patients remain on warfarin because of the high price of NOACs and variability in reimbursement coverage. To compensate clinical-evidence and achieve optimal use of NOACs, we should pay attention to the outcomes of ongoing studies and evaluate more real-world data.Keywords: non-valvular atrial fibrillation, venous thromboembolism, risk management plan, optimal dose, drug price, cost-effectivenessCho IYDove Medical Pressarticlenon-valvular atrial fibrillationvenous thromboembolismrisk management planoptimal dosedrug pricecost-effectivenessTherapeutics. PharmacologyRM1-950ENTherapeutics and Clinical Risk Management, Vol Volume 15, Pp 1183-1206 (2019)
institution	DOAJ
collection	DOAJ
language	EN
topic	non-valvular atrial fibrillation venous thromboembolism risk management plan optimal dose drug price cost-effectiveness Therapeutics. Pharmacology RM1-950
spellingShingle	non-valvular atrial fibrillation venous thromboembolism risk management plan optimal dose drug price cost-effectiveness Therapeutics. Pharmacology RM1-950 Cho IY Using non-vitamin K oral anticoagulants in specific patient populations: a study of Korean cases
description	Il Young Cho1,2 1College of Pharmacy, Ewhawomans University, Seoul, Republic of Korea; 2Pharmaceutical Safety Bureau, Ministry of Food and Drug Safety, Cheongju-si, Republic of KoreaCorrespondence: Il Young ChoPharmaceutical Safety Bureau, Ministry of Food and Drug Safety, 187, Osongsaengmyeong 2-ro, Osong-eup, Heungdeok-gu, Cheongju-si, Chungcheongbuk-do 28159, Republic of KoreaTel +82 43 719 2709Fax +82 43 719 2700Email iycho10@korea.krAbstract: Non-vitamin K oral anticoagulants (NOACs) are increasingly used as alternatives to conventional therapies and have considerable accumulated real-world clinical data in patients with non-valvular atrial fibrillation (NVAF) or venous thromboembolism (VTE). However, it is not easy to make a complete changeover to NOACs in real-world clinical practice because NOACs still have challenges in specific patient populations (eg, Asian patients, NVAF patients presenting with acute coronary syndrome [ACS], dialysis patients with NVAF, patients with cancer-associated VTE, etc.). Clinical data on the optimal dose of NOACs in Asian patients with NVAF are not sufficient. The intensity of NOAC and antiplatelet treatment and the duration of antiplatelet treatment should be adjusted according to the bleeding and thrombotic risk profiles of the individual NVAF patient presenting with ACS. Increased bleeding risk and unclear efficacy of NOACs in dialysis patients with NVAF should be considered when making decisions on whether to give NOACs for these patients. If dialysis patients with NVAF require anticoagulant for stroke prevention, then apixaban could be considered while awaiting more clinical efficacy and safety data. Additional studies are needed to determine the utility of continuing treatment with reduced-dose NOACs for long-term therapy after VTE. We have enough experiences in using NOACs in cancer patients showing the benefit of antithrombotic treatment counterbalanced the bleeding risk; however, some challenges of cancer-associated VTE management exist due to differences in cancer types or chemotherapy regimens and comorbidities. Different dosing regimens among NOACs may impact on medication adherence; thus, individual patient preference should be considered in choosing a particular NOAC. A significant proportion of patients remain on warfarin because of the high price of NOACs and variability in reimbursement coverage. To compensate clinical-evidence and achieve optimal use of NOACs, we should pay attention to the outcomes of ongoing studies and evaluate more real-world data.Keywords: non-valvular atrial fibrillation, venous thromboembolism, risk management plan, optimal dose, drug price, cost-effectiveness
format	article
author	Cho IY
author_facet	Cho IY
author_sort	Cho IY
title	Using non-vitamin K oral anticoagulants in specific patient populations: a study of Korean cases
title_short	Using non-vitamin K oral anticoagulants in specific patient populations: a study of Korean cases
title_full	Using non-vitamin K oral anticoagulants in specific patient populations: a study of Korean cases
title_fullStr	Using non-vitamin K oral anticoagulants in specific patient populations: a study of Korean cases
title_full_unstemmed	Using non-vitamin K oral anticoagulants in specific patient populations: a study of Korean cases
title_sort	using non-vitamin k oral anticoagulants in specific patient populations: a study of korean cases
publisher	Dove Medical Press
publishDate	2019
url	https://doaj.org/article/779b82ec483243e9a690a777716fbf5c
work_keys_str_mv	AT choiy usingnonvitaminkoralanticoagulantsinspecificpatientpopulationsastudyofkoreancases
_version_	1718395350452011008

Using non-vitamin K oral anticoagulants in specific patient populations: a study of Korean cases

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