We have compiled supportive data for usage of NOACs as Dabigatran, Aprixaban, Edoxaban, Rivaroaxaban etc for Valvular or Rheumatic AF.
Profs confusion and debate also has been going on for example no axe we all are aware that they can be used further non-value aureus however can they be used for the valve layers that’s what we’re gonna seat and discuss a lot until here so we all are very much aware of what warfarin was actually meant to be it was meant to be a rat poison right and it was like a
Accidental discovery that’s all it started being used as anticoagulants with the humans as well however we all are very much aware about its limitations as well not only its unpredictable the narrow therapeutic range is there in fact you need to monitor the myriad really regularly and the offset or the onset also is slightly unpredictable it takes a lot of time
There’s a lot of drug to drug interactions there’s a lot of drug to food interactions as well and in fact so that those were the reasons why the there has been ongoing researchers we’re trying to see for those newer molecules and that’s all they came up with the group of drugs called as no acts so the dabby action was one of the first ones which was introduced
Around 2009 in fact a later on of course there were new medications like the rivaroxaban apixaban a dope seban and there are some more as well so what has going on so i remember way back in 2012 we were sitting with our australian colleagues and friends and that’s where we try to sit together and we try to think like how does it affect can we compile the data
The safety efficacy and the side effects data as well and that’s how the first paper we would it up and then once we wrote it up we were requested by though it details a journal international journal of cardiology and compiled the data also about the rivaroxaban and also the second paper in fact came up and all the data was compiled up and be shown as well and
Of course published as well so we are all very much aware already there they have been included in the guidelines the guidelines the latest guidelines which i’m talking about it came in january 2019 the global expert consensus document so it already said it but yes it should be the first drug of choice however further non-value on years right so there should be
Preferred even over waffle so now coming back to the the main question which was talking about was about the value is so this was one of the first publications which came way back in march 2017 from renta at all which supported on those parameters and when they try to do compare the data how this evolved lahar disease patients who ever treated with booze no axe how
Are they doing so if we look carefully on this forest plot as well we can see very clearly that the safety parameters not just for the parameters like the stroke i think the major bleeding as well this there’s significant benefit for example for those patients who are using no axe versus the watchmen can’t agonists like the warfarin however i remember wherever we
Used to speak with our friends and colleagues as well there used to be large debate okay yes the valve the heart disease but definitely not further metro stenosis or rheumatic heart disease as well can it be possible so this was the another paper as well i see why i’m talking about all these publications because i think we all will agree we what we bought follow
Especially the current times as well as evidence-based medicine if evidence is there that’s what we were supposed to do we are supposed to follow it’s not like this that we have to be making fancy ideas that okay this needs to be done and we are doing it no so this was our other paper or poster presentation which was presented recently in fact they try to do a
Risk-benefit analysis about the usage of snow acts of course in the for the valve la ears patients in fact and when they try to compare with the fm patients so they really noted was that in fact all the new acts however except rivaroxaban so all the no acts was having what was have happening is they were much better than the warfarin in fact so what we can learn
From this is all the no acts are pretty safe except rivaroxaban but what was the problem with the reserved suburb was there was higher bleeding risk the major bleeding risk was pretty high in fact and that’s why the big question came that can we get a randomized control trial in fact so after this is well okay this was a positive data in fact which was favoring
The no acts usage and as i was telling you those parameters on which they try to notice it which we can see it over here clearly this slide in fact we so as i was telling you the most debatable talk has been like what about those rheumatic heart patients specially metal strauss’s so this was one of the papers which has been trying to really focus upon this group in
Fact especially for the metal stenosis so even for the metals versus what happens is when they try to accumulate a data of like more than 2200 patients it seems that in fact it’s it’s definitely a very promising therapy and so if what is going to really ask can we use it in our clinical scenario i would say when we try to see for those benefits in terms of ischemic
Stroke or systemic in baltimore use an intracranial hemorrhage these seems to be gaining more and more evidence more and more popularity as well we need to wait for further more details as well and is it possible even randomized control trials as well however we should be there with an open mind and on a receptive side hopefully we should be able to see some our
City’s prospective studies as well pretty soon maybe coming few years thank you so much for the patient hearing and feel free to share your comments and there were box below and i will be looking forward in fact this is the latest 2017 expert consensus document on a catheter ablation of af which came in late 2017 and again two of my papers husband effort the lower
One was about that anticoagulation enemies which i’ve already shared with you thank you so much
Transcribed from video
NOACs for Valvular or Rheumatic AF ? By HeartbeatszliveBroadcastDetails{isLiveNowfalsestartTimestamp2019-05-05T182108+0000endTimestamp2019-05-05T183022+0000}
