Expert Opinion on the Usage of Novel Oral Anticoagulants in Clinical Conditions in Indian Settings
Published: 2024-04-09
Page: 16-24
Issue: 2024 - Volume 6 [Issue 1]
Manjula S *
Department of Medical Services, Micro Labs Limited, Bangalore, Karnataka, India.
Krishna Kumar M
Department of Medical Services, Micro Labs Limited, Bangalore, Karnataka, India.
*Author to whom correspondence should be addressed.
Abstract
Objective: The current survey-based study aims to better understand expert opinion on the most commonly prescribed anticoagulants in clinical practice, with a special focus on the use of dabigatran in real-time clinical practice in an Indian setting.
Methodology: A cross-sectional study was conducted to examine the viewpoints of 183 experts from various regions in India regarding the use of dabigatran. The survey consisted of 16 questions to obtain expert responses regarding the usage of dabigatran in clinical practice. The data were analyzed using descriptive statistics.
Results: The study gathered responses from 183 clinicians. The majority of the clinicians (72%) recommended dabigatran as the most preferred anticoagulant. Approximately 76% of respondents recommended dabigatran for atrial fibrillation (AF). Dabigatran was identified as the most commonly recommended medication for both pulmonary embolism (PE) and deep vein thrombosis (DVT) by 69% of the respondents. The respondents also preferred the drug for managing other clinical conditions such as ischemic stroke and prophylaxis in hip replacement surgery. More than half (64%) of the respondents reported dabigatran to be more effective than rivaroxaban and apixaban.
Conclusion: Dabigatran emerged as the preferred anticoagulant in clinical practice. Dabigatran, among the anticoagulants, can be a top choice in AF, PE, DVT, ischemic stroke, and hip replacement surgery as therapy and prophylaxis.
Keywords: Anticoagulants, dabigatran, deep vein thrombosis, pulmonary embolism, atrial fibrillation, stroke
How to Cite
Downloads
References
Cardiovascular diseases; 2023 Jul 19 Available:https://www.who.int/health-topics/cardiovascular-diseases
Sreeniwas Kumar A, Sinha N. Cardiovascular disease in India: A 360 degree overview. Med J Armed Forces India. 2020 Jan;76(1):1–3.
Jaberinezhad M, Farhoudi M, Nejadghaderi SA, Alizadeh M, Sullman MJM, Carson-Chahhoud K, et al. The burden of stroke and its attributable risk factors in the Middle East and North Africa region, 1990–2019. Sci Rep. 2022 Feb 17;12(1):2700.
Waheed SM, Kudaravalli P, Hotwagner DT. Deep vein thrombosis. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2023. [cited 2023 Jul 19] Available:http://www.ncbi.nlm.nih.gov/books/NBK507708/
General (US) O of the S, National Heart L. Introduction: Definitions of deep vein thrombosis and pulmonary embolism. In: The surgeon general’s call to action to prevent deep vein thrombosis and pulmonary embolism. Office of the Surgeon General (US); 2008. [cited 2023 Jul 19] Available:https://www.ncbi.nlm.nih.gov/books/NBK44184/
Stone J, Hangge P, Albadawi H, Wallace A, Shamoun F, Knuttien MG, et al. Deep vein thrombosis: Pathogenesis, diagnosis, and medical management. Cardiovasc Diagn Ther. 2017 Dec;7(Suppl 3):S276–84.
Vyas V, Goyal A. Acute pulmonary embolism. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2023. [cited 2023 Jul 19] Available:http://www.ncbi.nlm.nih.gov/books/NBK560551/
Report of task force on venous thrombo embolism, national academy of medical sciences (India) Ministry of Health & family welfare government of India; 2023 Jul 19 Available:https://www.namsindia.in/downloads/Taskforce/01%20NAMS%20%20Task%20Force%20report%20%20on%20Venus%20Thrombo.pdf
Saggu DK, Rangaswamy VV, Yalagudri S, Sundar G, Reddy NK, Shah V, et al. Prevalence, clinical profile, and stroke risk of atrial fibrillation in rural Andhra Pradesh, India (the AP-AF study). Indian Heart J. 2022;74(2):86–90.
Raja DC, Kapoor A. Epidemiology of atrial fibrillation - An Indian perspective. J Assoc Physicians India. 2016 Aug;64(8 Suppl):7-10.
Tsai Hobart. Pharmacological review of anticoagulants. Mina Kelleni. (ed). Anticoagulation Drugs - the Current State of the Art; 2020.
Batta A, Kalra BS, Khirasaria R. Critical issues and recent advances in anticoagulant therapy: A review. Neurology India. 2019 Sep 1;67(5):1200.
Yeh CH, Hogg K, Weitz JI. Overview of the new oral anticoagulants. Arteriosclerosis, Thrombosis, and Vascular Biology. 2015 May;35(5):1056–65.
Thachil J. The newer direct oral anticoagulants: A practical guide. Clinical Medicine. 2014 Apr 1;14(2):165–75.
Dabigatran - an overview | ScienceDirect Topics; 2023 Jul 19 Available:https://www.sciencedirect.com/topics/pharmacology-toxicology-and-pharmaceutical-science/dabigatran
Muñoz-Corcuera M, Ramírez-Martínez-Acitores L, López-Pintor RM, Casañas-Gil E, Hernández-Vallejo G. Dabigatran: A new oral anticoagulant. Guidelines to follow in oral surgery procedures. A systematic review of the literature. Med Oral Patol Oral Cir Bucal. 2016 Nov;21(6):e679–88.
Tran A, Cheng-Lai A. Dabigatran etexilate: The first oral anticoagulant available in the United States since warfarin. Cardiol Rev. 2011;19(3):154–61.
railokya A, Hiremath JS. Dabigatran - the first approved DTI for SPAF. J Assoc Physicians India. 2018 Apr;66(4):85-90.
Connolly SJ, Ezekowitz MD, Yusuf S, Eikelboom J, Oldgren J, Parekh A, et al. Dabigatran versus warfarin in patients with atrial fibrillation. N Engl J Med. 2009 Sep 17;361(12):1139–51.
Diener HC, Connolly SJ, Ezekowitz MD, Wallentin L, Reilly PA, Yang S, et al. Dabigatran compared with warfarin in patients with atrial fibrillation and previous transient ischaemic attack or stroke: A subgroup analysis of the RE-LY trial. Lancet Neurol. 2010 Dec;9(12):1157–63.
Huang CW, Duan L, An J, Sim JJ, Lee MS. Effectiveness and safety of dabigatran in atrial fibrillation patients with severe obesity: A real-world retrospective cohort study. J Gen Intern Med. 2022 Sep;37 (12):2982–90.
Schulman S, Kearon C, Kakkar AK, Mismetti P, Schellong S, Eriksson H, et al. Dabigatran versus warfarin in the treatment of acute venous thromboembolism. N Engl J Med. 2009 Dec 10;361(24):2342–52.
Schulman S, Kakkar AK, Goldhaber SZ, Schellong S, Eriksson H, Mismetti P, et al. Treatment of acute venous thromboembolism with dabigatran or warfarin and pooled analysis. Circulation. 2014 Feb 18;129(7):764–72.
Schulman S, Kearon C, Kakkar AK, Schellong S, Eriksson H, Baanstra D, et al. Extended use of dabigatran, warfarin, or placebo in venous thromboembolism. N Engl J Med. 2013 Feb 21;368(8):709–18.
Klok FA, Toenges G, Mavromanoli AC, Barco S, Ageno W, Bouvaist H, et al. Early switch to oral anticoagulation in patients with acute intermediate-risk pulmonary embolism (PEITHO-2): A multinational, multicentre, single-arm, phase 4 trial. Lancet Haematol. 2021 Sep;8(9):e627–36.
Brandão LR, Tartakovsky I, Albisetti M, Halton J, Bomgaars L, Chalmers E, et al. Dabigatran in the treatment and secondary prophylaxis of venous thromboembolism in children with thrombophilia. Blood Adv. 2022 Nov 22;6(22):5908–23.
Ferro JM, Coutinho JM, Dentali F, Kobayashi A, Alasheev A, Canhão P, et al. Safety and efficacy of dabigatran etexilate vs dose-adjusted warfarin in patients with cerebral venous thrombosis: A randomized clinical trial. JAMA Neurology. 2019 Dec 1;76(12):1457–65.
Butcher KS, Ng K, Sheridan P, Field TS, Coutts SB, Siddiqui M, et al. Dabigatran treatment of acute noncardioembolic ischemic stroke. Stroke. 2020 Apr;51(4): 1190–8.
Alrohimi A, Ng K, Dowlatshahi D, Buck B, Stotts G, Thirunavukkarasu S, et al. Early dabigatran treatment after transient ischemic attack and minor ischemic stroke does not result in hemorrhagic transformation. Can J Neurol Sci. 2020 Sep;47(5):604–11.
Kate M, Gioia L, Buck B, Sivakumar L, Jeerakathil T, Shuaib A, et al. Dabigatran therapy in acute ischemic stroke patients without atrial fibrillation. Stroke. 2015 Sep;46(9):2685–7.
Eriksson BI, Dahl OE, Ahnfelt L, Kälebo P, Stangier J, Nehmiz G, et al. Dose escalating safety study of a new oral direct thrombin inhibitor, dabigatran etexilate, in patients undergoing total hip replacement: BISTRO I. J Thromb Haemost. 2004 Sep;2(9):1573–80.
Eriksson BI, Dahl OE, Büller HR, Hettiarachchi R, Rosencher N, Bravo ML, et al. A new oral direct thrombin inhibitor, dabigatran etexilate, compared with enoxaparin for prevention of thromboembolic events following total hip or knee replacement: the BISTRO II randomized trial. J Thromb Haemost. 2005 Jan;3(1):103–11.
Eriksson BI, Dahl OE, Rosencher N, Kurth AA, van Dijk CN, Frostick SP, et al. Dabigatran etexilate versus enoxaparin for prevention of venous thromboembolism after total hip replacement: A randomised, double-blind, non-inferiority trial. Lancet. 2007 Sep 15;370(9591):949–56.
Malhotra R, Babhulkar S, Sanjib KB, Clemens A, Dadi A, Iyer R, et al. Thromboprophylaxis with dabigatran after total hip arthroplasty in Indian patients: A subanalysis of a double-blind, double-dummy, randomized RE-NOVATE II study. Asian J Surg. 2017 Apr;40(2):145–51.
Rutherford OCW, Jonasson C, Ghanima W, Söderdahl F, Halvorsen S. Comparison of dabigatran, rivaroxaban, and apixaban for effectiveness and safety in atrial fibrillation: A nationwide cohort study. Eur Heart J Cardiovasc Pharmacother. 2020 Apr 1;6(2):75–85.
Noseworthy PA, Yao X, Abraham NS, Sangaralingham LR, McBane RD, Shah ND. Direct comparison of dabigatran, rivaroxaban, and apixaban for effectiveness and safety in nonvalvular atrial fibrillation. Chest. 2016 Dec;150(6): 1302–12.
Grymonprez M, De Backer TL, Bertels X, Steurbaut S, Lahousse L. Long-term comparative effectiveness and safety of dabigatran, rivaroxaban, apixaban and edoxaban in patients with atrial fibrillation: A nationwide cohort study. Front Pharmacol. 2023;14:1125576.
Villines TC, Ahmad A, Petrini M, Tang W, Evans A, Rush T, et al. Comparative safety and effectiveness of dabigatran vs. rivaroxaban and apixaban in patients with non-valvular atrial fibrillation: A retrospective study from a large healthcare system. Eur Heart J Cardiovasc Pharmacother. 2019 Apr 1;5 (2):80–90.
Mantha S, Ansell J. An indirect comparison of dabigatran, rivaroxaban and apixaban for atrial fibrillation. Thromb Haemost. 2012 Sep;108(3):476–84.