International Journal of the Cardiovascular Academy (Jan 2019)
Where will non-Vitamin K oral anticoagulants stand beyond being standard of care in anticoagulation therapy?
Abstract
Objective: Atrial fibrillation (AF) is the most common arrhythmia that increases risk of stroke by 4–5 fold. AF prevalence is approximately 1%–3% in the general population and increases with age. Until 2010, the standard of care (SoC) for prophylaxis of ischemic stroke was Vitamin K antagonists. Phase III randomized controlled trials (RCTs) of non-Vitamin K oral anticoagulants (NOACs) showed that NOACs have comparable or lower risk of stroke, systemic embolism, major bleeding, and death with warfarin in populations with nonvalvular AF (NVAF). Since then, results of these pivotal RCTs were confirmed by postmarketing studies and real-world data. In the last 8 years, they have been replacing warfarin as the SoC not only for preventing stroke in NVAF patients but also for patients with deep vein thrombosis, pulmonary embolism, and those who undergo hip or knee surgery. In recent years, there are emerging data on new clinical areas such as coronary and peripheral artery disease. In this article, it is attempted to review what has changed in the last 8–10 years in the management and prevention of stroke associated with NVAF and other thromboembolic situations and to foresee whether NOACs will be SoC and stand beyond being SoC in anticoagulation therapy. Methods: IMS data were obtained from IQVIA with a permission letter on request of Dr. Ergene. IQVIA grants permission to use the statements for the specified purpose (NOACs share in the total anticoagulation market and role of NOACs as the SoC in the near future) of peer-review publication by Dr. Ergene. Conclusion: NOACs are breakthrough in stroke prevention, and they will prevail eventually. It will take a few years; anticoagulation market will grow in favor of NOACs, and most probably, NOACs will reach over 50% standard unit market share. It is even more exciting to hear about new therapeutic areas and indications for these agents.
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