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Direct oral anticoagulants for the treatment and prevention of venous thromboembolism in patients with cancer: current evidence. Clin Transl Oncol 2020; 23:1034-1046. [PMID: 33206333 PMCID: PMC8084841 DOI: 10.1007/s12094-020-02506-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 09/28/2020] [Indexed: 12/11/2022]
Abstract
Venous thromboembolic disease (VTED) is a common and clinically important complication in patients with cancer, contributing to its mortality and morbidity. Direct oral anticoagulant agents (DOACs), including direct thrombin inhibitors and direct factor Xa inhibitors, are as effective as vitamin K antagonists for the treatment of VTED and are associated with less frequent and severe bleeding. They have advantages over low-molecular-weight heparin, but comparative long-term efficacy and safety data are lacking for these compounds. Recent randomized clinical trials suggest a role for DOACs in the treatment of VTED in patients with cancer. This review will discuss the existing evidence and future perspectives on the role of DOACs in the treatment of VTE based on the current evidence about their overall efficacy and safety and the limited information in patients with cancer; in addition, we will briefly review their pharmacokinetic properties with special reference to potential interactions.
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Gumprecht J, Domek M, Proietti M, Li YG, Asaad N, Rashed W, Alsheikh-Ali A, Zubaid M, Lip GYH. Compliance of Atrial Fibrillation Treatment with the Atrial Fibrillation Better Care (ABC) Pathway Improves the Clinical Outcomes in the Middle East Population: A Report from the Gulf Survey of Atrial Fibrillation Events (SAFE) Registry. J Clin Med 2020; 9:jcm9051286. [PMID: 32365582 PMCID: PMC7287832 DOI: 10.3390/jcm9051286] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 04/20/2020] [Accepted: 04/21/2020] [Indexed: 12/22/2022] Open
Abstract
Atrial fibrillation (AF) is associated with substantially increased risk of cardiovascular events and overall mortality. The Atrial fibrillation Better Care (A-Avoid stroke, B-Better symptom management, C-Cardiovascular and comorbidity risk management) pathway provides a simple and comprehensive approach for integrated AF therapy. This study's goals were to evaluate the ABC pathway compliance and determine the main gaps in AF management in the Middle East population, and to assess the impact of ABC pathway adherence on the all-cause mortality and composite outcome in AF patients. 2021 patients (mean age 57; 52% male) from the Gulf SAFE registry were studied. We evaluated: A-appropriate implementation of OACs according to CHA2DS2-VASc score; B-symptom control according to European Heart Rhythm Association (EHRA) symptom scale; C-proper cardiovascular comorbidities management. The primary endpoints were the composite cardiovascular outcome (ischemic stroke or systemic embolism, all-cause death and cardiovascular hospitalization) and all-cause mortality. One-hundred and sixty-eight (8.3%) patients were optimally managed according to adherence with the ABC pathway. Over the one-year follow up (FU), there were 578 composite outcome events and 224 deaths. Patients managed with integrated care had significantly lower rates for the composite outcome and mortality comparing to non-ABC group (20.8% vs. 29.3%, p = 0.02 and 7.3% vs. 13.1%, p = 0.033, respectively). On multivariable analysis, ABC compliance was independently associated with reduced risk of composite outcome (HR 0.53; 95% CI 0.36-0.8, p = 0.002) and death (HR 0.46; 95% CI 0.25-0.86, p = 0.015). Integrated ABC pathway adherent care resulted in the reduced composite outcome and all-cause mortality in AF patients from Middle East, highlighting the necessity of promoting comprehensive holistic and integrated care management of AF.
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Affiliation(s)
- Jakub Gumprecht
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool L7-8TX, UK; (J.G.); (M.D.); (M.P.)
- Department of Cardiology, Medical University of Silesia, Silesian Centre for Heart Diseases, 41-800 Zabrze, Poland
| | - Magdalena Domek
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool L7-8TX, UK; (J.G.); (M.D.); (M.P.)
- Department of Internal Diseases, Diabetology and Nephrology, Medical University of Silesia, 41-800 Zabrze, Poland
| | - Marco Proietti
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool L7-8TX, UK; (J.G.); (M.D.); (M.P.)
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
| | - Yan-Guang Li
- Department of Cardiology, Peking University Third Hospital, Beijing 100191, China;
| | - Nidal Asaad
- Cardiology Department, Heart Hospital, Hamad Medical Corporation, Doha 3050, Qatar;
| | - Wafa Rashed
- Department of Medicine, Mubarak Al-Kabeer Hospital, Jabriya, Kuwait University, Kuwait City 24923, Kuwait;
| | - Alawi Alsheikh-Ali
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai 505055, UAE;
| | - Mohammad Zubaid
- Department of Medicine, Mubarak Al-Kabeer Hospital, Jabriya, Kuwait University, Kuwait City 24923, Kuwait;
- Correspondence: (M.Z.); (G.Y.H.L.)
| | - Gregory Y. H. Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool L7-8TX, UK; (J.G.); (M.D.); (M.P.)
- Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, 9100 Aalborg, Denmark
- Department of Cardiology, Medical University of Silesia, Silesian Centre for Heart Diseases, 41-800 Zabrze, Poland
- Correspondence: (M.Z.); (G.Y.H.L.)
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