Current clinician perspective on non-vitamin K antagonist oral anticoagulant use in challenging clinical cases

dc.contributor.authorTurk, Ugur Onsel
dc.contributor.authorAcar, Rezzan Deniz
dc.contributor.authorAkgun, Taylan
dc.contributor.authorEmren, Volkan
dc.contributor.authorKanat, Selcuk
dc.contributor.authorKaracaglar, Emir
dc.contributor.authorKepez, Alper
dc.contributor.authorKul, Seref
dc.contributor.authorOzel, Erdem
dc.contributor.authorSimsek, Evrim
dc.contributor.authorTuluce, Selcen Yakar
dc.contributor.authorTuluce, Kamil
dc.contributor.authorCamm, A. John
dc.contributor.orcID0000-0002-2538-1642en_US
dc.contributor.pubmedID32281950en_US
dc.contributor.researcherIDABI-6723-2020en_US
dc.date.accessioned2021-06-21T08:34:02Z
dc.date.available2021-06-21T08:34:02Z
dc.date.issued2020
dc.description.abstractObjective: The evolution of non-vitamin K antagonist anticoagulants (NOACs) has changed the horizon of stroke prevention in atrial fibrillation (SPAF). All 4 NOACs have been tested against dose-adjusted warfarin in well-designed, pivotal, phase III, randomized, controlled trials (RCTs) and were approved by regulatory authorities for an SPAF indication. However, as traditional RCTs, these trials have important weaknesses, largely related to their complex structure and patient participation, which was limited by strict inclusion and extensive exclusion criteria. In the real world, however, clinicians are often faced with complex, multimorbid patients who are underrepresented in these RCTs. This article is based on a meeting report authored by 12 scientists studying atrial fibrillation (AF) in diverse ways who discussed the management of challenging AF cases that are underrepresented in pivotal NOAC trials. Methods: An advisory board panel was convened to confer on management strategies for challenging AF cases. The article is derived from a summary of case presentations and the collaborative discussions at the meeting. Conclusion: This expert consensus of cardiologists aimed to define management strategies for challenging cases with patients who underrepresented in pivotal trials using case examples from their routine practice. Although strong evidence is lacking, exploratory subgroup analysis of phase III pivotal trials partially informs the management of these patients. Clinical trials with higher external validity are needed to clarify areas of uncertainty. The lack of clear evidence about complex AF cases has pushed clinicians to manage patients based on clinical experience, including rare situations of off-label prescriptions.en_US
dc.identifier.endpage303en_US
dc.identifier.issn1016-5169en_US
dc.identifier.issue3en_US
dc.identifier.scopus2-s2.0-85083546488en_US
dc.identifier.startpage289en_US
dc.identifier.urihttps://archivestsc.com/jvi.aspx?un=TKDA-16359
dc.identifier.urihttp://hdl.handle.net/11727/6129
dc.identifier.volume48en_US
dc.identifier.wos000526091700009en_US
dc.language.isoengen_US
dc.relation.isversionof10.5543/tkda.2020.16359en_US
dc.relation.journalTURK KARDIYOLOJI DERNEGI ARSIVI-ARCHIVES OF THE TURKISH SOCIETY OF CARDIOLOGYen_US
dc.relation.publicationcategoryMakale - Uluslararası Hakemli Dergien_US
dc.rightsinfo:eu-repo/semantics/openAccessen_US
dc.subjectAtrial fibrillationen_US
dc.subjectnon-vitamin K antagonist oral anticoagulanten_US
dc.subjectreal lifeen_US
dc.titleCurrent clinician perspective on non-vitamin K antagonist oral anticoagulant use in challenging clinical casesen_US
dc.typearticleen_US

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