Oral Anticoagulation and the Novel Oral Anticoagulants (NOACs):Where Are We at Midterm?

Academic Content

Program Overview

Faculty Presentations

Introduction Deepak L. Bhatt Elaine Hylek

Video Roundtable

Current Activity

Elaine Hylek, MD, MPH, Boston University School of Medicine, Boston, Massachusetts

NOACs in Clinical Care NOACS Prevention Data NOACS: Major Bleeding Meta-Analysis ESC 2012 Guidelines Update Garfield Registry Prophylaxis vs Anticoagulation Clinical Trial: Major Bleeding Benefit and Risk Bleeding Risk Score Consensus Statements CHA2DS2-VASc Bleeding Risk Score Circulation Article Patient Age vs TTR NOACs vs Warfarin NOACS & Renal Dysfunction EHRA NOACs Practical Guide Procedural Management NOACs Bleeding Management Life-threatening Hemorrhage CAT Scans of Cerebral Hemorrhage Intracerebral Hemorrhage: Limited Data Kcentra: FDA approval Safety: Meta-analysis Anticoagulation Antidotes Dose Differences: AFib vs VTE NOACS in Clinical Practice Continuing role for warfarin?

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Pharmacokinetics of NOACs in Patients with Varying Levels of Renal Dysfunction

Figure 17 shows some of the details concerning elimination half-life for apixaban, dabigatran, and rivaroxaban.[13] These data show how elimination half-life varies with different levels of kidney function. Thus in the context of renal impairment with a spectrum of creatinine clearance that decreases from >80 mL/min to <30 mL/min, the physician can expect that the elimination half-life for patients on apixaban will increase from under 8 to just over 17 hours; with dabigatran the change will be from almost 14 to 27.5 hours; and for rivaroxaban the change will be the least, with the elimination half-life rising from 8.3 to 9.5 hours.

Hylek EM. Am J Med 2014; 00.

References

[13]

Kaatz S, Mahan CF. Stroke prevention in patients with atrial fibrillation and renal dysfunction. Stroke. 2014;45:2497-2505.