Oral anticoagulants in coronary heart disease (Section IV) Position paper of the ESC Working Group on Thrombosis – Task Force on Anticoagulants in Heart Disease

Raffaele De Caterina; Steen Husted; Lars Wallentin; Felicita Andreotti; Harald Arnesen; Fedor Bachmann; Colin Baigent; Jean-Philippe Collet; Sigrun Halvorsen; Kurt Huber; Jørgen Jespersen; Steen Dalby Kristensen; Gregory Y. H. Lip; João Morais; Lars Hvilsted Rasmussen; Fabrizio Ricci; Dirk Sibbing; Agneta Siegbahn; Robert F. Storey; Jurrien ten Berg; Freek W. A. Verheugt; Jeffrey I. Weitz

doi:10.1160/TH15-09-0703

Thrombosis and Haemostasis, Inhaltsverzeichnis

Thromb Haemost 2016; 115(04): 685-711
DOI: 10.1160/TH15-09-0703

Position Paper

Schattauer GmbH

Oral anticoagulants in coronary heart disease (Section IV) Position paper of the ESC Working Group on Thrombosis – Task Force on Anticoagulants in Heart Disease

Raffaele De Caterina^*^**

¹“G. d’Annunzio” University, Chieti and Fondazione Toscana “G. Monasterio”, Pisa, Italy

,

Steen Husted^*^**

²University of Aarhus, Aarhus, Denmark

,

Lars Wallentin^*^**

³Uppsala Clinical Research Center, University of Uppsala, Sweden

,

Felicita Andreotti^**

⁴Catholic University, Rome, Italy

,

Harald Arnesen^**

⁵Oslo University Hospital Ullevál and University of Oslo, Oslo, Norway

,

Fedor Bachmann^**

⁶University of Lausanne, Lausanne, Switzerland

,

Colin Baigent^**

⁷University of Oxford, Oxford, United Kingdom

,

Jean-Philippe Collet^**

⁸INSERM UMRS-ICAN 1166, Groupe Hospitalier Pitié-Salpétriére, Paris, France

,

Sigrun Halvorsen^**

⁵Oslo University Hospital Ullevál and University of Oslo, Oslo, Norway

,

Kurt Huber^**

⁹Wilhelminenhospital, Vienna, Austria

,

Jørgen Jespersen^**

¹⁰University of Southern Denmark, Esbjerg, Denmark

,

Steen Dalby Kristensen^**

¹¹Aarhus University Hospital, Aarhus, Denmark

,

Gregory Y. H. Lip^**

¹²University of Birmingham Institute of Cardiovascular Sciences, City Hospital, Birmingham, UK

,

João Morais^**

¹³Hospital Santo Andre, Leiria, Portugal

,

Lars Hvilsted Rasmussen^**

¹⁴Aalborg University, Aalborg, Denmark

,

Fabrizio Ricci^**

¹“G. d’Annunzio” University, Chieti and Fondazione Toscana “G. Monasterio”, Pisa, Italy

,

Dirk Sibbing^**

¹⁵Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Ludwig-Maximilians-Universität München, Munich, Germany, DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany

,

Agneta Siegbahn^**

³Uppsala Clinical Research Center, University of Uppsala, Sweden

,

Robert F. Storey^**

¹⁶University of Sheffield, Sheffield, UK

,

Jurrien ten Berg^**

¹⁷St Antonius Hospital, Nieuwegein, the Netherlands

,

Freek W. A. Verheugt^**

¹⁸Onze Lieve Vrouwe Gasthuis, Amsterdam, Netherlands

,

Jeffrey I. Weitz

¹⁹McMaster University and Thrombosis and Atherosclerosis Research Institute, Hamilton, Ontario, Canada

› Institutsangaben

Abstract

Summary

Until recently, vitamin K antagonists (VKAs) were the only available oral anticoagulants evaluated for long-term treatment of patients with coronary heart disease (CHD), particularly after an acute coronary syndrome (ACS). Despite efficacy in this setting, VKAs are rarely used because they are cumbersome to administer. Instead, the more readily manageable antiplatelet agents are the mainstay of prevention in ACS patients. This situation has the potential to change with the introduction of non-VKA oral anticoagulants (NOACs), which are easier to administer than VKAs because they can be given in fixed doses without routine coagulation monitoring. The NOACs include dabigatran, which inhibits thrombin, and apixaban, rivaroxaban and edoxaban, which inhibit factor Xa. Apixaban and rivaroxaban were evaluated in phase III trials for prevention of recurrent ischaemia in ACS patients, most of whom were also receiving dual antiplatelet therapy with aspirin and clopidogrel. Although at the doses tested rivaroxaban was effective and apixaban was not, both agents increased major bleeding. The role for the NOACs in ACS management, although promising, is therefore complicated, because it is uncertain how they compare with newer antiplatelet agents, such as prasugrel, ticagrelor or vorapaxar, and because their safety in combination with these other drugs is unknown. Ongoing studies are also now evaluating the use of NOACs in non-valvular atrial fibrillation patients, where their role is established, with coexistent ACS or coronary stenting. Focusing on CHD, we review the results of clinical trials with the NOACs and provide a perspective on their future incorporation into clinical practice.

Note: The review process for this paper was fully handled by Christian Weber, Editor in Chief.

Keywords

Anticoagulants - vitamin K antagonists - non-vitamin K antagonist oral anticoagulants - dabigatran etexilate - rivaroxaban - apixaban - edoxaban - coronary heart disease - acute coronary syndrome

Volltext

Referenzen

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