title: Oral anticoagulants in coronary heart disease (Section IV). Position paper of the ESC Working Group on Thrombosis - Task Force on Anticoagulants in Heart Disease.
abstract: Until recently, vitamin K antagonists (VKAs) were the only available oral anticoagulants evaluated for long-term treatment of patients with coronary heart disease (CHD), particularly after an acute coronary syndrome (ACS). Despite efficacy in this setting, VKAs are rarely used because they are cumbersome to administer. Instead, the more readily manageable antiplatelet agents are the mainstay of prevention in ACS patients. This situation has the potential to change with the introduction of non-VKA oral anticoagulants (NOACs), which are easier to administer than VKAs because they can be given in fixed doses without routine coagulation monitoring. The NOACs include dabigatran, which inhibits thrombin, and apixaban, rivaroxaban and edoxaban, which inhibit factor Xa. Apixaban and rivaroxaban were evaluated in phase III trials for prevention of recurrent ischaemia in ACS patients, most of whom were also receiving dual antiplatelet therapy with aspirin and clopidogrel. Although at the doses tested rivaroxaban was effective and apixaban was not, both agents increased major bleeding. The role for the NOACs in ACS management, although promising, is therefore complicated, because it is uncertain how they compare with newer antiplatelet agents, such as prasugrel, ticagrelor or vorapaxar, and because their safety in combination with these other drugs is unknown. Ongoing studies are also now evaluating the use of NOACs in non-valvular atrial fibrillation patients, where their role is established, with coexistent ACS or coronary stenting. Focusing on CHD, we review the results of clinical trials with the NOACs and provide a perspective on their future incorporation into clinical practice.
authors.affiliation: Raffaele De Caterina, MD, PhD, Institute of Cardiology, "G. d'Annunzio" University - Chieti, Ospedale SS. Annunziata, Via dei Vestini, 66013 Chieti, Italy, E-mail: rdecater@unich.it.
authors.forename: Raffaele
authors.initials: R
authors.lastname: De Caterina
authors.forename: Steen
authors.initials: S
authors.lastname: Husted
authors.forename: Lars
authors.initials: L
authors.lastname: Wallentin
authors.forename: Felicita
authors.initials: F
authors.lastname: Andreotti
authors.forename: Harald
authors.initials: H
authors.lastname: Arnesen
authors.forename: Fedor
authors.initials: F
authors.lastname: Bachmann
authors.forename: Colin
authors.initials: C
authors.lastname: Baigent
authors.forename: Jean-Philippe
authors.initials: JP
authors.lastname: Collet
authors.forename: Sigrun
authors.initials: S
authors.lastname: Halvorsen
authors.forename: Kurt
authors.initials: K
authors.lastname: Huber
authors.forename: Jørgen
authors.initials: J
authors.lastname: Jespersen
authors.forename: Steen Dalby
authors.initials: SD
authors.lastname: Kristensen
authors.forename: Gregory Y H
authors.initials: GY
authors.lastname: Lip
authors.forename: João
authors.initials: J
authors.lastname: Morais
authors.forename: Lars Hvilsted
authors.initials: LH
authors.lastname: Rasmussen
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Ricci
authors.forename: Dirk
authors.initials: D
authors.lastname: Sibbing
authors.forename: Agneta
authors.initials: A
authors.lastname: Siegbahn
authors.forename: Robert F
authors.initials: RF
authors.lastname: Storey
authors.forename: Jurriën
authors.initials: J
authors.lastname: Ten Berg
authors.forename: Freek W A
authors.initials: FW
authors.lastname: Verheugt
authors.forename: Jeffrey I
authors.initials: JI
authors.lastname: Weitz
mesh_terms: D000284:Administration, Oral; D000818:Animals; D000925:Anticoagulants / Q000627:therapeutic use*; D002986:Clinical Trials as Topic; D003324:Coronary Artery Disease / Q000188:drug therapy*; D000069604:Dabigatran / Q000627:therapeutic use; D004347:Drug Interactions; D006801:Humans; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011720:Pyrazoles / Q000627:therapeutic use; D011725:Pyridines / Q000627:therapeutic use; D011728:Pyridones / Q000627:therapeutic use; D000069552:Rivaroxaban / Q000627:therapeutic use; D013844:Thiazoles / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors; D011720:Pyrazoles; D011725:Pyridines; D011728:Pyridones; D013844:Thiazoles; C522181:apixaban; D000069552:Rivaroxaban; D000069604:Dabigatran; C552171:edoxaban
keywords: Anticoagulants; acute coronary syndrome; apixaban; coronary heart disease; dabigatran etexilate; edoxaban; non-vitamin K antagonist oral anticoagulants; rivaroxaban; vitamin K antagonists