Using NOACs in Various Clinical Situations

Mary Beth Nierengarten

doi:10.1177/155989771442013

Article Figures & Data

Figures

Tables

Download figure
Open in new tab
Download powerpoint
Figure 1.
Dabigatran: Trough Level Associated With Bleeding and Stroke
DE, dabigatran; SEE, systemic embolic event.Adapted from Journal of the American College of Cardiology, 63, Reilly PA et al. The effect of dabigatran plasma concentrations and patient characteristics on the frequency of ischemic stroke and major bleeding in atrial fibrillation patients: the RE-LY Trial (Randomized Evaluation of Long-Term Anticoagulation Therapy). 321–328, Copyright (2014), with permission from American College of Cardiology Foundation.
Download figure
Open in new tab
Download powerpoint
Figure 2.
Risk Stratification of Patients on Novel Oral Anticoagulants by Severity of Bleeding
DIC, disseminated intravascular coagulation; PCC, prothrombin complex concentrate; RBC, red blood cell. ^aPreferred agent for rivaroxaban/apixaban. ^bPreferred agent for dabigatran.Adapted from Blood, Siegal DM et al. How I treat target-specific oral anticoagulant-associated bleeding. 2014;123:1152–1158. With permission of American Society of Hematology. Permission conveyed through Copyright Clearance Center, Inc.
Download figure
Open in new tab
Download powerpoint
Figure 3.
ESC/EHRA/EAPCI/ACCA 2014 Consensus Statement Algorithm
For step 4, background color and gradients reflect the intensity of antithrombotic therapy (eg, dark background color: high intensity; light background color: low intensity). Solid boxes indicate recommended drugs; dashed boxes indicate optional drugs depending on clinical judgment. A new generation drug-eluting stent is generally preferable over a bare-metal stent, particularly in patients at low bleeding risk (HAS-BLED score 0–2). When vitamin K antagonists are used as part of triple therapy, the international normalized ratio should be targeted at 2.0 to 2.5, and the time in the therapeutic range should be > 70%.A, aspirin; ACCA, Acute Cardiovascular Care Association; ACS, acute coronary syndrome; C, clopidogrel; CAD, coronary artery disease; DAPT, dual antiplatelet therapy; DES, drug-eluting stent; EAPCI, European Association of Percutaneous Cardiovascular Interventions; EHRA, European Heart Rhythm Association; ESC, European Society of Cardiology; INR, international normalized ratio; O, oral anticoagulation; PCI, percutaneous coronary intervention. ^aDual therapy with oral anticoagulation and clopidogrel may be considered in selected patients. ^bAspirin as an alternative to clopidogrel may be considered in patients on dual therapy (ie, oral anticoagulation plus single antiplatelet). ^cDual therapy with oral anticoagulation and an antiplatelet agent (aspirin or clopidogrel) may be considered in patients at very high risk of coronary events.Adapted from Lip GY et al. Management of antithrombotic therapy in atrial fibrillation patients presenting with acute coronary syndrome and/or undergoing percutaneous coronary or valve interventions: a joint consensus document of the European Society of Cardiology Working Group on Thrombosis, European Heart Rhythm Association (EHRA), European Association of Percutaneous Cardiovascular Interventions (EAPCI) and European Association of Acute Cardiac Care (ACCA) endorsed by the Heart Rhythm Society (HRS) and Asia-Pacific Heart Rhythm Society (APHRS). Eur Heart J. 2014; First published online: 26 August 2014. DOI: http://dx.doi.org.ezp-prod1.hul.harvard.edu/10.1093/eurheartj/ehu298. With permission from European Society of Cardiology.