How to personalize NOAC for special populations and special situations
Non antivitamins K Oral Anti-Coagulants (NOAC) have emerged as a new class of antithrombotic drugs. Four randomized large scale trials (RCT) accredited dabigatran, rivaroxaban, apixaban and edoxaban as superior for stroke prevention in atrial fibrillation (AF) when compared with warfarin. The superiority concerns not only the manageability (no need for coagulation monitoring, more predicable effect) but also the antithrombotic efficacy and especially the safety. Many subgroup analyses, meta-analyses registries and post-market surveillances confirmed the positive results of the RCTs and NOACs are now a reality in clinical practice. One important practical question regards the clinical decision for a specific agent, a specific dosage and a suitable monitoring test in special situations. Different from VKA, the NOAC class comprises different molecules, acting on different vulnerable targets of the coagulation cascade. This fact implies differences in physiological actions, in available test for monitoring and in dosages in special situations. Despite the fact that the accumulated evidence is still insufficient to indicate a general acceptable principle for the individualization of therapy based on differences between NOAC molecules a better knowledge of specific pharmacokinetic properties, physiology, auxiliary effects and testing methods help the physician to evaluate a clinical based indication. Moreover, the advantage of a limited number of dosages is a "two edged sword"; the principle of "one fits all" is no more suitable in special populations (very elderly, comorbidities, Asian patients...). As the long history of drug therapy demonstrated, personalization of therapy is the best target of our clinical judgement.
Key Learning Objectives
This webinar is to inform and educate cardiologists and cardiac surgeons on:
- Advantages of NOAC in clinical practice
- Pharmacological and clinical differences of NOAC
- When and how to individualize NOAC therapy
- Interventional cardiologists
- Internal medicine fellows in practice
Dr Gheorghe-Andrei Dan is Head of Internal Medicine University Clinic, Colentina University Hospital, Bucharest and Head of the Cardiology Department and Diagnostic Cardiovascular Procedures and Arrhythmology Unit – University Hospital Colentina.
Professor – Internal Medicine Department of the University of Medicine and Pharmacy “Carol Davila” Bucharest
Head, Internal Medicine Chair, University of Medicine and Pharmacy “Carol Davila” Bucharest
Leading Research Investigator of the Romanian Academy of Medical Sciences
Chancellor (Scientific Secretary), Faculty of Medicine, University of Medicine “Carol Davila”- Bucharest
Dr Gheorghe-Andrei Dan is on the Editorial Board of European Cardiology Review.
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