Season 1, Episode 3, Part 1 of 2:
For Anticoagulation, These Times They are a-Changin’
Take Home Points:
- Rivaroxaban, apixaban, edoxaban and dabigatran are the new oral anticoagulants (NOACs). In general they are as safe and effective as warfarin for VTE and afib.
- CHEST guidelines were updated Jan 2016. Highlights include:
- NOACs as first line for VTE in patients without cancer.
- Low risk patients with subsegmental PE do not always require anticoagulation
- Fall related bleeding is commonly overestimated. Several warfarin trials showed that fall related bleeds are uncommon and fall related intracranial hemorrhage is a rare complication.
Links from the Show:
A great starting point for learning the NOACs
An indepth review article and summary of the new oral anticoagulants
Updated CHEST guidelines 2016
The original HAS-BLED article
A novel user-friendly score (HAS-BLED) to assess 1-year risk of major bleeding in patients with atrial fibrillation: the Euro Heart Survey. Chest. 2010 Nov;138(5):1093-100. doi: 10.1378/chest.10-0134. Epub 2010 Mar 18.
A few articles that tell us bleeding related to falls are overestimated by physicians
Stroke and major bleeding risk in elderly patients aged ≥75 years with atrial fibrillation: the Loire Valley atrial fibrillation project. Stroke. 2015 Jan;46(1):143-50. doi: 10.1161/STROKEAHA.114.007199. Epub 2014 Nov 25.