PECULIARITIES OF USE OF ANTITHROMBOTIC DRUGS WARFARIN AND XARELTO IN PATIENTS WITH CORONARY HEART DISEASE
Keywords:
atrial fibrillation, anticoagulant therapy, thromboembolic complicationsAbstract
Objective: The study investigates the characteristics of the utilization of antithrombotic medications warfarin and Xarelto among patients diagnosed with coronary heart disease.
Methods: This research was conducted over a span of 1.5 years, from 2020 to 2022, at the Department of Cardiology within the Multidisciplinary Medical Center of the Bukhara region. Within this study, a total of 76 patients (42 men and 34 women) aged between 60 and 74 years were assessed, with men comprising 55.3% and women 44.7%. The cohort encompassed 44 patients (36 men and 8 women) diagnosed with ischemic heart disease necessitating myocardial revascularization, among whom 33 exhibited persistent atrial fibrillations, with 11 presenting long-term persistent forms of the condition.
Results: The observational study conducted on a restricted patient sample utilizing NOACs (New Oral Anticoagulants) as part of antithrombotic treatment post-coronary artery bypass grafting, individuals exhibited a decreased occurrence of thromboembolic complications (TEC) and hemorrhagic complications in contrast to those administered warfarin. However, due to the limited sample size, no statistically significant variances between the groups were discerned. Undoubtedly, clinical trials involving a larger patient cohort in this domain hold promise.
Conclusion: In hospitalized patients with coronary artery disease complicated by atrial fibrillation, it was observed that in 16% of cases, the dosage of a new oral anticoagulant prescribed exceeded the therapeutic dose. Comparative studies between NOACs, specifically rivaroxaban, and warfarin indicated that patients receiving warfarin spent only 64% of their time within the therapeutic range of INR (2-3). These trials underscored that NOACs are equally efficacious as warfarin in preventing thromboembolic complications, with a superior safety profile and enhanced ease of administration.
References
1. Hindricks G, Potpara T, Dagres N, et al. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association of Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2021; 42(5):373-498. https://doi.org/10.1093/eurheartj/ehaa612.
2. Larina V.N., Oinotkinova O.Sh., Mayorova A.P. An integrated approach to the management of a multimorbid patient with atrial fibrillation from the standpoint of modern recommendations.
2021; 17(3):484-91. https://doi.org/10.20996/1819-6446-2021-06-05.
3. Watanabe H, Watanabe T, Sasaki Sh, et al. Close bidirectional relationship between chronic kidney disease and atrial fibrillation. 2009; 158(4):629-36. https://doi.org/10.1016/j.ahj.2009.06.031.
4. Gomez-Outes A, Lagunar-Rwz J, Terleira-Fernandez A-I, et al. Causes of Death in Anticoagulated Patients with Atrial Fibrillation. 2016; 68(23):2508-21. https://doi.org/10.1016/j.jacc.2016.09.944.
5. Turov A.N., Panfilov S.V., Chiglintseva O.V. Efficacy, safety and adherence when using new anticoagulants in patients with atrial fibrillation over 75 years of age. Rational Pharmacotherapy in Cardiology. 2020; 16(1):10-8. https://doi.org/10.20996/1819-6446-2020-20-07.
6. Bracey A, Shatila W, Wilson J. Bleeding in patients receiving non-vitamin K oral anticoagulants: clinical trial evidence. Therapeutic Advances in Cardiovascular Disease. 2018; 12(12):361-80. https://doi.org/10.1177/1753944718801554.
7. Beyer-Westendorf J, Marten S, Naue Ch, et al. Rates, management and outcome of bleeding complications during edoxaban therapy in daily care - results from the DRESDEN NOAC REGISTRY. 2020; 190:91-8. https://doi.org/10.1016/j.thromres.2020.03.021.
8. Feng X, Sambamoorthi U, Innes K, et al. Predictors of Major Bleeding Among Working-Age Adults with Atrial Fibrillation. 2018; 32(6):591-600. https://doi.org/10.1007/s10557-018-6825-7.
9. Milling TJ Jr, Frontera J. Exploring indications for the Use of direct oral anticoagulants and the associated risks of major bleeding. Am J Manag Care. 2017; 23(4 Suppl):S67-S80.
10. Ono S, Ishikawa M, Matsuda K, et al. Clinical impact of the perioperative management of oral anticoagulants in bleeding after colonic endoscopic mucosal resection. BMC Gastroenterol. 2019; 19(1):206. https://doi.org/10.1186/s12876-019-1124-8.
11. Patel MR, Mahaffey KW, Garg J, et al.; ROCKET AF Investigators. Rivaroxaban versus warfarin in nonvalvular atrial fibrillation. N Engl J Med.
2011; 365(10):883-91. https://doi.org/10.1056/NEJMoa1009638.
12. Hanon O, Vidal JS, Pisica-Donose G, et al. Bleeding risk with rivaroxaban compared with vitamin K antagonists in patients aged 80 years or older with atrial fibrillation. Heart. 2021;107(17):1376-82. https://doi.org/10.1136/heartjnl-2020-3179237.
13. Kropacheva E.S. Practical aspects of therapy with new oral anticoagulants in patients with impaired renal function. Cardiology. 2014; 2:78-83. https://doi.org/10.18565/cardio.2014.4.78-83.
14. Male C, Lensing AWA, Palumbo JS, et al. Rivaroxaban Compared With Standard Anticoagulants for the Treatment of Acute Venous Thromboembolism in Children. 2020;7(1):e18-e27.
https://doi.org/10.1016/S2352-3026 (19)30219-4.
15. Steffel J, Collins R, Antz M, et al. 2021 European Heart Rhythm Association Practical Guide on the Use of Non-Vitamin K Antagonist Oral Anticoagulants in Patients with Atrial Fibrillation. Europace. 2021; 23(10):1612-76. https://doi.org/10.1093/europace/euab065.
16. Connolly SJ, Ezekowitz MD, Yusuf S, et al., the RE-LY Steering Committee and Investigators. Dabigatran versus warfarin in patients with atrial fibrillation. N Engl J Med. 2009;361:1139-51. https://doi.org/10.1056/NEJMoa0905561.
17. Lopes RD, Alexander JH, Al-Khatib SM, et al. Apixaban for reduction in stroke and other ThromboemboLic events in atrial fibrillation (ARISTOTLE) trial: design and rationale. Am Heart J. 2010; 159:331-9. https://doi.org/10.1016/j.ahj.2009.07.035.
18. Lukyanov M.M., Boytsov S.A., Yakushin S.S. and others. Diagnosis, treatment, combined cardiovascular pathology and concomitant diseases in patients diagnosed with atrial fibrillation in real outpatient practice. 2014; 10(4):366-77. https://doi.org/10.20996/1819-6446-2014-10-4-366-377.
19. Granger CB, Alexander JH, McMurray JJ, et al. Apixaban versus warfarin in patients with atrial fibrillation. N Engl J Med. 2011; 365(11):981-92. https://doi.org/10.1056/NEJMoa1107039.
20. Halperin J, Hankey G, Wojdyla D, et al. Efficacy and safety of rivaroxaban compared with warfarin among elderly patients with nonvalvular atrial fibrillation 2014;130(2):138-46.
https://doi.org/10.1161/CIRCULATIONAHA.113.005008.
21. Halvorsen S, Atar D, Yang H, et al. Efficacy and safety of apixaban compared with warfarin according to age for stroke prevention in atrial fibrillation 2014;35(28):1864-72.
https://doi.org/10.1093/eurheartj/ehu046.
22. Barco S, Cheung W, Eikelboom J, et al. New oral anticoagulants in elderly patients. Best Pract Res Clin Haematol. 2013; 26:215-24.
