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Gerfer S, Wahlers T, Kuhn E. Is There an Alternative Oral Anticoagulation to Vitamin-K-Antagonists for Patients with Mechanical Aortic Valve Replacement? - A Literature Review. Cardiol Ther 2024; 13:453-463. [PMID: 38753086 PMCID: PMC11333642 DOI: 10.1007/s40119-024-00371-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Accepted: 05/01/2024] [Indexed: 08/20/2024] Open
Abstract
Current guidelines exclusively recommend vitamin-K-antagonists (VKA) as anticoagulation for patients after mechanical aortic valve replacement due to the increased postoperative risk of valve thrombosis and thrombo-embolism. Strict and regular assessments are mandatory during VKA therapy to ensure a potent anticoagulatory effect within the desired range. From the patients' perspective, VKA are associated with relevant interactions and side effects reducing the quality of life and contributing to a high number of patients not achieving the optimal therapeutic target. Direct oral anticoagulants (DOAC) have replaced VKA therapy in the past for several indications, e.g., atrial fibrillation. However, it is still unclear if DOACs could replace VKA therapy in patients after mechanical aortic valve replacement. While the PROACT-Xa study did not show a sufficient anticoagulatory effect of apixaban plus aspirin compared to VKA therapy in patients after mechanical aortic valve replacement, the direct thrombin inhibitor dabigatran and the oral factor Xa inhibitors apixaban and rivaroxaban showed promising results in comparable patient cohorts in smaller studies and case reports. Factor Xa inhibitors were able to prevent thrombosis and thrombo-embolic events in patients after mechanical aortic valve replacement. Therefore, factor Xa inhibitors or factor XI inhibitors could provide a potent alternative to VKA for patients after a mechanical aortic valve replacement.
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Affiliation(s)
- Stephen Gerfer
- Department of Cardiothoracic Surgery, Heart Center, University Hospital of Cologne, Kerpener Straße 62, 50937, Cologne, Germany.
| | - Thorsten Wahlers
- Department of Cardiothoracic Surgery, Heart Center, University Hospital of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Elmar Kuhn
- Department of Cardiothoracic Surgery, Heart Center, University Hospital of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
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Willems S, A. Gunawardene M, Eickholt C, Hartmann J, Schmoeckel M, Schäffer B. Medical, Interventional, and Surgical Treatment Strategies for Atrial Fibrillation. DEUTSCHES ARZTEBLATT INTERNATIONAL 2022; 119:arztebl.m2022.0002. [PMID: 34789364 PMCID: PMC9002302 DOI: 10.3238/arztebl.m2022.0002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 07/14/2021] [Indexed: 06/09/2023]
Abstract
BACKGROUND Atrial fibrillation is the most common type of cardiac arrhythmia; the lifetime risk for a 55-year-old person to develop atrial fibrillation is 37%. In recent years, years there have been various distinct changes in the clinical management of AF. METHODS This review is based on a selective search for literature on the treatment of AF and the prevention of thromboembolic complications. The updated guideline of the European Society of Cardiology (ESC) for the diagnosis and treatment of AF was also taken into consideration. RESULTS The main components of AF management are the comprehensive treatment of risk factors and concomitant diseases, as well as the prevention of thromboembolic complications, usually with non-vitamin-K-dependent oral anticoagulants or vitamin K antagonists, according to individual risk stratification. Beyond this, either rate or rhythm control are viable treatment concepts. Symptomatic patients in whom reversible causes have been ruled out should be offered rhythm-control therapy early in their course. In patients with risk factors and/or heart failure, an early rhythm control strategy has been found to be beneficial. As antiarrhythmic drugs often prove to be ineffective over the long term, catheter ablation is now becoming increasingly important in AF management. CONCLUSION The clinical management of atrial fibrillation consists of a multimodal approach with risk stratification, lifestyle modification, prevention of thromboembolism, and, if possible, early rhythm control therapy.
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Affiliation(s)
- Stephan Willems
- Department of Cardiology and Internal Intensive Care Medicine, Asklepios Hospital St. Georg, Hamburg
- Asklepios proresearch, Hamburg
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Berlin
- AFNET, Münster
| | - Melanie A. Gunawardene
- Department of Cardiology and Internal Intensive Care Medicine, Asklepios Hospital St. Georg, Hamburg
- Asklepios proresearch, Hamburg
| | - Christian Eickholt
- Department of Cardiology and Internal Intensive Care Medicine, Asklepios Hospital St. Georg, Hamburg
- Asklepios proresearch, Hamburg
| | - Jens Hartmann
- Department of Cardiology and Internal Intensive Care Medicine, Asklepios Hospital St. Georg, Hamburg
- Asklepios proresearch, Hamburg
| | - Michael Schmoeckel
- Department of Cardiac Surgery, Center for Cardiac and Vascular Medicine, Asklepios Hospital St. Georg, Hamburg
| | - Benjamin Schäffer
- Department of Cardiology and Internal Intensive Care Medicine, Asklepios Hospital St. Georg, Hamburg
- Asklepios proresearch, Hamburg
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Korff M, Imberg L, Will JM, Bückreiß N, Kalinina SA, Wenzel BM, Kastner GA, Daniliuc CG, Barth M, Ovsepyan RA, Butov KR, Humpf HU, Lehr M, Panteleev MA, Poso A, Karst U, Steinmetzer T, Bendas G, Kalinin DV. Acylated 1H-1,2,4-Triazol-5-amines Targeting Human Coagulation Factor XIIa and Thrombin: Conventional and Microscale Synthesis, Anticoagulant Properties, and Mechanism of Action. J Med Chem 2020; 63:13159-13186. [DOI: 10.1021/acs.jmedchem.0c01635] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Marvin Korff
- Institute of Pharmaceutical and Medicinal Chemistry, University of Münster, Corrensstraße 48, 48149 Münster, Germany
| | - Lukas Imberg
- Institute of Pharmaceutical and Medicinal Chemistry, University of Münster, Corrensstraße 48, 48149 Münster, Germany
| | - Jonas M. Will
- Institute of Inorganic and Analytical Chemistry, University of Münster, Corrensstraße 30, 48149 Münster, Germany
| | - Nico Bückreiß
- Pharmaceutical Institute, University of Bonn, An der Immenburg 4, 53121 Bonn, Germany
| | - Svetlana A. Kalinina
- Institute of Food Chemistry, University of Münster, Corrensstraße 45, 48149 Münster, Germany
| | - Benjamin M. Wenzel
- Department of Pharmacy, Institute of Pharmaceutical Chemistry, Philipps University Marburg, Marbacher Weg 6, 35032 Marburg, Germany
| | - Gregor A. Kastner
- Institute of Pharmaceutical and Medicinal Chemistry, University of Münster, Corrensstraße 48, 48149 Münster, Germany
| | - Constantin G. Daniliuc
- Institute for Organic Chemistry, University of Münster, Corrensstraße 40, 48149 Münster, Germany
| | - Maximilian Barth
- Institute of Pharmaceutical and Medicinal Chemistry, University of Münster, Corrensstraße 48, 48149 Münster, Germany
| | - Ruzanna A. Ovsepyan
- Laboratory of Translational Medicine, Dmitriy Rogachev National Medical Research Center of Pediatric Hematology, Oncology, and Immunology, Samory Mashela str. 1, GSP-7, 117997 Moscow, Russia
- Center for Theoretical Problems of Physicochemical Pharmacology, Russian Academy of Sciences, 4 Kosygina St, 119991 Moscow, Russia
| | - Kirill R. Butov
- Laboratory of Translational Medicine, Dmitriy Rogachev National Medical Research Center of Pediatric Hematology, Oncology, and Immunology, Samory Mashela str. 1, GSP-7, 117997 Moscow, Russia
- Center for Theoretical Problems of Physicochemical Pharmacology, Russian Academy of Sciences, 4 Kosygina St, 119991 Moscow, Russia
| | - Hans-Ulrich Humpf
- Institute of Food Chemistry, University of Münster, Corrensstraße 45, 48149 Münster, Germany
| | - Matthias Lehr
- Institute of Pharmaceutical and Medicinal Chemistry, University of Münster, Corrensstraße 48, 48149 Münster, Germany
| | - Mikhail A. Panteleev
- Laboratory of Translational Medicine, Dmitriy Rogachev National Medical Research Center of Pediatric Hematology, Oncology, and Immunology, Samory Mashela str. 1, GSP-7, 117997 Moscow, Russia
- Faculty of Physics, Lomonosov Moscow State University, 1/2 Leninskie gory, 119991 Moscow, Russia
- Center for Theoretical Problems of Physicochemical Pharmacology, Russian Academy of Sciences, 4 Kosygina St, 119991 Moscow, Russia
- Faculty of Biological and Medical Physics, Moscow Institute of Physics and Technology, 9 Institutskii per., 141700 Dolgoprudnyi, Russia
| | - Antti Poso
- School of Pharmacy, Faculty of Health Sciences, University of Eastern Finland, 70211 Kuopio, Finland
- Department of Internal Medicine VIII, University Hospital Tübingen, 72076 Tübingen, Germany
| | - Uwe Karst
- Institute of Inorganic and Analytical Chemistry, University of Münster, Corrensstraße 30, 48149 Münster, Germany
| | - Torsten Steinmetzer
- Department of Pharmacy, Institute of Pharmaceutical Chemistry, Philipps University Marburg, Marbacher Weg 6, 35032 Marburg, Germany
| | - Gerd Bendas
- Pharmaceutical Institute, University of Bonn, An der Immenburg 4, 53121 Bonn, Germany
| | - Dmitrii V. Kalinin
- Institute of Pharmaceutical and Medicinal Chemistry, University of Münster, Corrensstraße 48, 48149 Münster, Germany
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Kohler C, Fuss T, Schweizer R, Baumgartner I, Kucher N, Schindewolf M. Haemostaseological complication management in caval and iliac venous stenting. VASA 2018; 47:243-246. [PMID: 29336234 DOI: 10.1024/0301-1526/a000686] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Antiplatelet and anticoagulation therapy after venous stenting is still not standardized, data from randomized-controlled trials are missing. Rare prothrombotic disorders and nonresponsiveness to drugs must be taken into account. This case report demonstrates successful haemostaselogical complication management in recurrent rethromboses due to underlying clopidogrel resistance and low responsiveness to anticoagulation with dabigatran after endovascular stent reconstruction of chronic pelvic and caval vein occlusion in a patient with severe postthrombotic syndrome.
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Affiliation(s)
- Corinne Kohler
- 1 Division of Vascular Surgery, Swiss Cardiovascular Center, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Torsten Fuss
- 2 Division of Angiology, Swiss Cardiovascular Center, Inselspital, Bern University Hospital, Bern, Switzerland.,3 Division of Angiology, Elblandklinikum Radebeul, Radebeul, Germany
| | - Ronny Schweizer
- 2 Division of Angiology, Swiss Cardiovascular Center, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Iris Baumgartner
- 2 Division of Angiology, Swiss Cardiovascular Center, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Nils Kucher
- 2 Division of Angiology, Swiss Cardiovascular Center, Inselspital, Bern University Hospital, Bern, Switzerland.,4 Division of Angiology, Zurich University Hospital, Zurich, Switzerland
| | - Marc Schindewolf
- 2 Division of Angiology, Swiss Cardiovascular Center, Inselspital, Bern University Hospital, Bern, Switzerland
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Abstract
Patients with derangements of secondary hemostasis resulting from inherited or acquired thrombophilias are at increased risk of venous thromboemboli (VTE). Evaluation of a patient with suspected VTE proceeds via evidence-based algorithms that involve computing a pretest probability based on the history and physical examination; this guides subsequent work-up, which can include D dimer and/or imaging. Testing for hypercoagulable disorders should be pursued only in patients with VTE with an increased risk for an underlying thrombophilia. Direct oral anticoagulants are first-line VTE therapies, but they should be avoided in patients who are pregnant, have active cancer, antiphospholipid antibody syndrome, severe renal insufficiency, or prosthetic heart valves.
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Affiliation(s)
- Marie A Hollenhorst
- Internal Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA
| | - Elisabeth M Battinelli
- Division of Hematology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA.
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