Triple antithrombotic therapy with warfarin is the standard of care in AF patients undergoing PCI, but this is associated with a high risk of bleeding. RE-DUAL PCI study compared trial triple therapy with warfarin and dual therapy with dabigatran post-PCI in patients with AF. Some important differences observed in primary and secondary end points have been shown here.

Dr. Cannon CP shares the results from RE-DUAL PCI that compared dual therapy with dabigatran versus triple therapy with warfarin. Evaluation of primary and secondary end points yielded vital data on safety and efficacy outcomes with these anticoagulants. Dual therapy with dabigatran was found to be as effective as triple therapy with warfarin in managing overall thromboembolic events.

This Q&A with Dr. Christopher P. Cannon discusses relevant implications of the RE-DUAL PCI study results in considering dual therapy with dabigatran and triple therapy with warfarin in managing AF patients post PCI.

Anticoagulation in atrial fibrillation have come a long way as Dr. Georg Nickenig shares treatment options for patients undergoing and post-PCI. The 2018 ESC expert consensus recommends discharging patients on triple therapy or dual therapy on concerns of thromboembolic events or bleeding risks respectively. Here, Dr. Georg Nickenig shares imperative evidences from recent studies that show a shift towards dual therapy post PCI/post ACS in patients with NVAF.

This Q&A deals with setting new standards for patients with AF - AC 2019 Barcelona with the panel Dr. Marc Brouwer, Dr. Elaine Hylek, Dr. Georg Nickenig and Dr. Todd Villnes along with hosts Dr. John Eikelboom and Dr. Harry Buller.

Dr. Dominick Angiolillo opines that AF patients undergoing PCI need protection from stroke. He shares the results of RE-DUAL PCI trial comparing dabigatran dual therapy versus warfarin triple therapy, to help physicians make better informed choices and minimize the risk of bleeding and mortality.

Use of PPI to reduce the risk of bleeding can affect the absorption of other drugs post PCI in patients with atrial fibrillation. The RE-DUAL PCI sub-analysis provides insights of the impact of baseline PPI on safety endpoints when tested with both the doses of dabigatran versus triple therapy.

AF patients undergoing PCI already on oral anticoagulant (OAC) therapy may need to switch to a different OAC for a variety of reasons. Switching OAC therapies can result in increased risk of bleeding and thromboembolic complications particularly in post PCI setting. The results from RE-DUAL PCI sub-group analysis prove otherwise. The RE-DUAL PCI sub-group analysis reassures safe switch to both doses of dabigatran in post PCI setting irrespective of prior OAC or warfarin use.

Dr. Marc Brouwer takes on the clinical data of uninterrupted dabigatran versus warfarin in periprocedural AF ablation from the RE-CIRCUIT trial and goes on to compare with the results from VENTURE-AF, AXAFA-AFNET 5 trial using other NOACs. He also shares the current guidance for the management of bleeding and cardiac tamponade from anticoagulation therapy.

The RE-CIRCUIT trial provides insights on the safety profile of uninterrupted dabigatran compared to uninterrupted warfarin in nonvalvular atrial fibrillation (NVAF) patients undergoing catheter ablation.

Professor Dr. Martin Grond shares his clinical experience about a patient with TIA and brain hemorrhage. He shares his practice experience on the possibility of controlling hematoma growth in patients taking anticoagulants with a specific antidote.

Professor Dr. Martin Grond describes idarucizumab, its mode of action and method of administration and elaborates how this reversal agent can provide value to dabigatran treated patients undergoing emergency surgery or with life-threatening bleeding.

In patient on effective anticoagulation therapy, suffering from an ischemic stroke, is thrombolysis possible? Know it better from Professor Dr. Martin Grond.

During urgent interventions, normalizing coagulation values is a crucial step. Professor Dr. Martin Grond emphasizes the administration of idarucizumab in patients undergoing emergency surgeries, as he shares his experience with the drug.

The availability of specific reversal agent can change lives of people on anticoagulation therapy. Idarucizumab is the specific reversal agent for dabigatran that can be utilized as a rescue strategy in clinical scenarios of life-threatening bleeding and urgent surgical or medical intervention. Given his in-clinic experiences, Professor Dr. Martin Grond couldn’t agree more.

Use of direct oral anticoagulants has bridged the need for effective anticoagulation in patients with atrial fibrillation. Professor Anna Tomaszuk-Kazberuk throws light on the efficacy and safety of direct oral anticoagulants and use of idarucizumab to reverse their anticoagulant effect, when needed.

Professor Anna Tomaszuk-Kazberuk discusses a case where cardiac surgeons initially refused to operate a patient on anticoagulant treatment and how idarucizumab has paved the way for proceeding with the contemplated procedure.

Professor Anna Tomaszuk-Kazberuk elaborates on how the use of idarucizumab changed the opinion of cardiac surgeons from withholding an emergency procedure for an imminent life-threatening condition to performing the same, while the patient was on dabigatran.

An elderly lady who had previous stroke and maintained on dabigatran had massive bleeding from her genital tract, as seen by her gynecologist. Professor Anna Tomaszuk-Kazberuk tells us how idarucizumab served as her rescue drug.

There are circumstances that may need for emergency reversal of anticoagulation in order to save lives of patients. Professor Anna Tomaszuk-Kazberuk deliberates on the use of idarucizumab by citing different clinical scenarios which were successfully managed with administration of idarucizumab based on her clinical experience.

Prof. Dr. med. Martin Grond provides a neurologist’s perspective on the reversibility of NOAC therapies and in specific about reversing dabigatran anticoagulant effects using idarucizumab in life threatening emergency situations like ischemic stroke and ICH, based on a retrospective study and real-world experience.

DOACs carry a risk of bleeding as with all antithrombotic therapies. A humanized monoclonal antibody was developed to reverse dabigatran anticoagulant effects in rare emergency situations. Let us see the mechanism of action of this antidote, idarucizumab.

The safety profile of dabigatran is built on evidences from RCTs and comprehensive data from real-world studies; together these provide information to the medical practitioners about its safety compared to VKAs and other NOACs.

Professor Gregory Lip compares the approach behind conducting randomized clinical trials and real-world studies for medical intervention. He also elaborates on how real-world evidence on dabigatran therapy has provided supportive and complimentary data to RCTs and contributed to improved patient outcomes.

'50 countries, 5 regions, 2200 sites': GLORIA AF – one of the largest prospective RWE study, and provides long term comparative real-world outcomes of oral anticoagulants for AF.

The medical speaker forum for stroke prevention in atrial fibrillation 2021 aimed to discuss the latest development in the field of anticoagulation and updates in the use of specific reversal agents for patients on NOAC. The meeting provided a platform to discuss with Regional Medical Experts how this latest clinical data impacts current clinical practice within the ASEAN and SK region with the aim of ensuring the appropriate use of NOACs for better patient care. It is also provided opportunity for sharing Patient Cases and how current data supports the use of NOACs for the right patient at the appropriate dose.

Professor Gregory Lip highlights the benefits of dabigatran (NOACs) for AF patients requiring anticoagulation therapy while citing evidence from some key clinical trial studies and real-world data of dabigatran showing a significant relative risk reduction in ischemic stroke, systemic embolism, intracranial hemorrhage and all-cause mortality when compared to OACs or other NOACs. The availability of idarucizumab, a specific dabigatran reversal agent adds greater control and is an important factor in oral anticoagulation therapy.

The Anticoagulation Webinar is entitled Clinical Trial Data, AF Guidelines and Real World Evidence in SPAF discusses the developments in the field of anticoagulation care, latest available Guidelines in SPAF appreciation of Current Phase 3 data and Real World Evidence in SPAF. The meeting provided a platform to discuss how clinical evidences, updated clinical practice Guidelines in AF and Individual Risk factors are important considerations in the safe and appropriate use of NOACs for SPAF.