Interpreting Findings with Non-Vitamin K Antagonist Oral Anticoagulants in Atrial Fibrillation: Collective Views on Data from Seminal Studies to Present in Clinical Practice

This symposium took place on 28th August 2016 as a part of the European Society of Cardiology (ESC) Congress, in Rome, Italy

Chairpersons: Jafna L. Cox,1 Christoph Bode2
Speakers: Manesh R. Patel,3 Eric D. Peterson,4 Peter Verhamme,5 Jafna L. Cox1

1. Division of Cardiology, Dalhousie University, Halifax, Nova Scotia, Canada
2. Chairman, Department of Cardiology and Angiology I, University Heart Center Freiburg; Chairman, Department of Medical Intensive Care, University Clinic Freiburg, Freiburg, Germany
3. Associate Professor of Medicine, Director of Interventional Cardiology, Duke University Health System, Durham, North Carolina, USA
4. Professor of Medicine, Director, Duke Clinical Research Institute, Durham, North Carolina, USA
5. Department of Cardiovascular Medicine, University of Leuven, Leuven, Belgium

Disclosure: Prof Cox is an advisor/consultant for Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, and Pfizer. He is also a speaker/speaker’s bureau member for, and has received clinical research grants from, Bayer. Prof Bode is an advisor/consultant and speaker/speaker’s bureau member for Bayer, Daiichi Sankyo, and MSD. He has also received clinical research grants from Bayer, Medtronic, MSD, and Sanofi. Prof Patel has received research funding from Janssen, AstraZeneca, Maquet, HeartFlow, CSI, and NHLBI, and has received consultancy/advisory board fees from AstraZeneca, Bayer, Janssen, and Genzyme. Prof Peterson has received research funding from Janssen and has received consultancy fees from Janssen, Bayer, Boehringer Ingelheim, Sanofi, AstraZeneca, Merck, Valeant, and Signal Path. Prof Verhamme provides honoraria and research support for Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Daiichi-Sankyo, Ionis Pharmaceuticals, Leo-Pharma, Pfizer, and Sanofi.
Acknowledgements: Writing assistance was provided by Tabasum Mughal of ApotheCom.
Support: The symposium and the publication of this article was funded by Bayer. The views and opinions expressed are those of the authors and not necessarily of Bayer.
Citation: EMJ Cardiol. 2016;4[1]:34-41.

Meeting Summary

Clinical trials show that non-vitamin K antagonist oral anticoagulants (NOACs) have good efficacy-safety profiles relative to warfarin across a broad spectrum of patients with non-valvular atrial fibrillation (NVAF). These findings are currently being confirmed for rivaroxaban through real-world evidence, with results from these studies consistent with results from Phase III randomised controlled trials (RCTs). Of all the NOACs, rivaroxaban currently has the most extensive real-world experience across different data sources (prospective and retrospective registries, database analyses, and prospective studies). Anticoagulantrelated bleeding is still a concern amongst clinicians, however awareness of patient characteristics and other factors that can increase bleeding risk can assist in the proactive and effective management of bleeding episodes. Particularly, in atrial fibrillation (AF) patients with renal impairment who have an incrementally higher risk of bleeding and stroke, administration of NOACs versus vitamin K antagonists (VKAs) is beneficial. When dosed appropriately, NOACs such as rivaroxaban are effective in patients with renal impairment and offer an alternative to warfarin, with increased efficacy and decreased risk of critical bleeding events.

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