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Anticoagulants oraux directs et insuffisance cardiaque
- Source :
- Archives of cardiovascular diseases, Archives of cardiovascular diseases, Elsevier/French Society of Cardiology, 2016, 109 (11), pp.641--650. ⟨10.1016/j.acvd.2016.08.001⟩, Archives of cardiovascular diseases, 2016, 109 (11), pp.641--650. ⟨10.1016/j.acvd.2016.08.001⟩
- Publication Year :
- 2016
- Publisher :
- Elsevier BV, 2016.
-
Abstract
- National audience; Thromboembolism contributes to morbidity and mortality in patients with heart failure (HF), and atrial fibrillation (AF) is one of the main factors promoting this complication. As they share many risk factors, HF and AF frequently coexist, and patients with both conditions are at a particularly high risk of thromboembolism. Non-vitamin K antagonist oral anticoagulants (NOACs) are direct antagonists of thrombin (dabigatran) and factor Xa (rivaroxaban, apixaban and edoxaban), and were designed to overcome the limitations of vitamin K antagonists. Compared with warfarin in non-valvular AF, NOACs demonstrated non-inferiority with better safety, most particularly for intracranial haemorrhages. Therefore, the European Society of Cardiology guidelines recommend NOACs for most patients with non-valvular AF. Subgroups of patients with both AF and HF from the pivotal studies investigating the safety and efficacy of NOACs have been analysed and, for each NOAC, results were similar to those of the total analysis population. A recent meta-analysis of these subgroups has confirmed the better efficacy and safety of NOACs in patients with AF and HF – particularly the 41% decrease in the incidence of intracranial haemorrhages. The prothrombotic state associated with HF suggests that patients with HF in sinus rhythm could also benefit from treatment with NOACs. However, in the absence of clinical trial data supporting this indication, current guidelines do not recommend anticoagulant treatment of patients with HF in sinus rhythm. In conclusion, recent analyses of pivotal studies support the use of NOACs in accordance with their indications in HF patients with non-valvular AF. © 2016 Elsevier Masson SAS
- Subjects :
- medicine.medical_specialty
Vitamin K
medicine.drug_class
Population
Administration, Oral
030204 cardiovascular system & hematology
Dabigatran
03 medical and health sciences
chemistry.chemical_compound
0302 clinical medicine
Edoxaban
Thromboembolism
Internal medicine
medicine
Humans
Vitamin K antagonits
030212 general & internal medicine
education
Heart Failure
Rivaroxaban
education.field_of_study
business.industry
Non-vitamin K antagonists oral anticoagulants
Warfarin
Anticoagulants
Atrial fibrillation
General Medicine
Vitamin K antagonist
medicine.disease
3. Good health
chemistry
Heart failure stroke
Cardiology
[SDV.IB]Life Sciences [q-bio]/Bioengineering
Apixaban
Cardiology and Cardiovascular Medicine
business
medicine.drug
Subjects
Details
- ISSN :
- 18752136 and 18752128
- Volume :
- 109
- Database :
- OpenAIRE
- Journal :
- Archives of Cardiovascular Diseases
- Accession number :
- edsair.doi.dedup.....c19be4deb53e38ba82b3d10d330c5f32