European Journal of Clinical Pharmacology

, Volume 70, Issue 7, pp 817–828 | Cite as

Potential use of NOACs in developing countries: pros and cons

  • Durga Bista
  • Leanne Chalmers
  • Luke Bereznicki
  • Gregory Peterson
Review Article

Abstract

Purpose

Although vitamin K antagonists (VKAs) are effective for long-term thromboprophylaxis in atrial fibrillation (AF), their limitations have led to widespread underutilisation, especially in the developing world. Novel oral anticoagulants (NOACs) have emerged as promising alternatives to VKAs, although there are some particular considerations and challenges to their introduction in developing countries. This review summarises the current state of antithrombotic management of AF in the developing world, explores the early evidence for the NOACs and describes some of the special considerations that must be taken into account when considering the role of the NOACs within developing countries’ health care systems.

Methods

A literature search was conducted via PubMed and Google Scholar to find articles published in English between the years 2000 to 2014. Search terms used were “atrial fibrillation”, “oral anticoagulants”, “warfarin”, “NOACs”, “dabigatran”, “rivaroxaban”, “apixaban”, “edoxaban”, “time in therapeutic range”, “International Normalized Ratio” “cost-effectiveness”, “stroke”, “adverse-drug reactions” and “drug–drug interactions”, together with the individual names of developing countries as listed by the World Bank. We reviewed the results of randomized clinical trials, relevant retrospective and prospective studies, case-studies and review articles.

Results

Many developing countries lack or have sporadic data on the quality of AF management, making it difficult to anticipate the potential impact of NOACs in these settings. The utilisation of anticoagulants for AF appears highly variable in developing countries. Given the issues associated with VKA therapy in many developing countries, NOACs offer some potential advantages; however, there is insufficient evidence to advocate the widespread replacement of warfarin at present. VKAs may continue to have a role in selected patients or countries, especially if alternative monitoring strategies can be utilised.

Conclusion

The evaluation of the introduction of NOACs should consider safety, budget concerns and the quality of oral anticoagulation care achieved by each country. Prospective registries will be important in developing countries to better elucidate the comparative safety, efficacy and cost-effectiveness of NOACs and VKAs as NOACs are introduced into practice.

Keywords

Atrial fibrillation Stroke Antithrombotic drugs Warfarin Novel oral anticoagulants Patient adherence 

Notes

Contributions of Authors statement (with relevance to the ICMJE Guidelines)

DB: Contribution to interpretation of data, involvement in literature search, manuscript writing

LC: Contribution to manuscript drafting, critical revising and final approval of the version to be published

LB: Contribution to critical manuscript revising and final approval of the version to be published

GP: Contribution to the conception of the work, manuscript review and final approval of the version to be published

Conflict of interest

Leanne Chalmers, Luke Bereznicki and Gregory Peterson have received consultancy funding from Aspen Pharmacare Australia and Boehringer Ingelheim. Luke Bereznicki has also received consultancy funding from Roche Diagnostics Australia and Sanofi Aventis and speaker honorarium payments from Roche Diagnostics Australia and Boehringer Ingelheim.

References

  1. 1.
    Tsang TS, Miyasaka Y, Barnes ME et al (2005) Epidemiological profile of atrial fibrillation: a contemporary perspective. Prog Cardiovasc Dis 48(1):1–8PubMedGoogle Scholar
  2. 2.
    Stewart S, Hart CL, Hole DJ et al (2002) A population-based study of the long-term risks associated with atrial fibrillation: 20-year follow-up of the Renfrew/Paisley study. Am J Med 113(5):359–364PubMedGoogle Scholar
  3. 3.
    Camm AJ, Baumgartner H, Ceconi C et al (2012) 2012 focused update of the ESC Guidelines for the management of atrial fibrillation: an update of the 2010 ESC Guidelines for the management of atrial fibrillation developed with the special contribution of the European Heart Rhythm Association. Eur Heart J 14(10):1385–1413Google Scholar
  4. 4.
    You JJ, Singer DE, Howard PA et al (2012) Antithrombotic therapy for atrial fibrillation: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 141(2 Suppl):e531S–e575SPubMedCentralPubMedGoogle Scholar
  5. 5.
    Country and lending groups. The World Bank. http://data.worldbank.org/about/country-classifications/country-and-lending-groups (2012). Accessed 25 December 2013
  6. 6.
    Nugent R (2008) Chronic diseases in developing countries: health and economic burdens. Ann N Y Acad Sci 1136:70–79PubMedGoogle Scholar
  7. 7.
    Lafuente-Lafuente C, Mahé I, Extramiana F (2009) Management of atrial fibrillation. BMJ 339:b5216PubMedGoogle Scholar
  8. 8.
    Freestone B, Lip GYH (2003) Epidemiology and costs of cardiac arrhythmias. In: Lip GYH, Godfredsen J (eds) Cardiac arrhythmias; a clinical approach. Edinburgh: Mosby; pp 3–24Google Scholar
  9. 9.
    Nguyen TN, Hilmer SN, Cumming RG (2013) Review of epidemiology and management of atrial fibrillation in developing countries. Int J Cardiol 167(6):2412–2420PubMedGoogle Scholar
  10. 10.
    Li Y, Wu YF, Chen KP et al (2013) Prevalence of atrial fibrillation in china and its risk factors. Biomed Environ Sci 26(9):709–716PubMedGoogle Scholar
  11. 11.
    Healey JS, Oldgren J, Parekh Aea (2011) Global variation in the etiology and management of atrial fibrillation: results from a global atrial fibrillation registry. Circulation 124 (21)Google Scholar
  12. 12.
    Okello E, Wanzhu Z, Musoke C et al (2013) Cardiovascular complications in newly diagnosed rheumatic heart disease patients at Mulago Hospital, Uganda. Cardiovasc J Afr 24(3):80–85PubMedGoogle Scholar
  13. 13.
    Feigin VL, Forouzanfar MH, Krishnamurthi R et al (2013) Global and regional burden of stroke during 1990–2010: findings from the Global Burden of Disease Study 2010. Lancet 383(9913):245–254Google Scholar
  14. 14.
    Alkali NH, Bwala SA, Akano AO et al (2013) Stroke risk factors, subtypes, and 30-day case fatality in Abuja, Nigeria. Niger Med J 54(2):129–135PubMedCentralPubMedGoogle Scholar
  15. 15.
    Guo GB, Chang HW, Chen MC et al (2001) Underutilization of anticoagulation therapy in chronic atrial fibrillation. Jpn Heart J 42(1):55–65PubMedGoogle Scholar
  16. 16.
    Mesas CE, Veloso HH, De Paola AA (2004) Anticoagulation for atrial fibrillation: underutilization in a Brazilian tertiary outpatient clinic. Clin Cardiol 27(11):592–593PubMedGoogle Scholar
  17. 17.
    Devkota KC, Thapamagar SB, Malla S (2006) Retrospective analysis of stroke and its risk factors at Nepal Medical College Teaching Hospital. Nepal Med Coll J 8(4):269–275PubMedGoogle Scholar
  18. 18.
    Pathak V, Kanth R, Pant H (2006) Stroke: a case series study in Nepal Medical College Teaching Hospital. Nepal Med Coll J 8(3):180–181PubMedGoogle Scholar
  19. 19.
    Robert GH, Lesly AP, Maria IA (2007) Meta-analysis: antithrombotic therapy to prevent stroke in patients who have nonvalvular atrial fibrillation. Ann Intern Med 146(12):857–867Google Scholar
  20. 20.
    Olesen JB, Gislason GH, Torp-Pedersen C et al (2011) Risks of thromboembolism and bleeding with thromboprophylaxis in patients with atrial fibrillation: a net clinical benefit analysis using a 'real world' nationwide cohort study. Thromb Haemost 106(4):739–749PubMedGoogle Scholar
  21. 21.
    Friberg L, Rosenqvist M, Lip GY (2012) Net clinical benefit of warfarin in patients with atrial fibrillation: a report from the Swedish atrial fibrillation cohort study. Circulation 125(19):2298PubMedGoogle Scholar
  22. 22.
    Banerjee A, Lane DA, Torp-Pedersen C et al (2012) Net clinical benefit of new oral anticoagulants (dabigatran, rivaroxaban, apixaban) versus no treatment in a 'real world' atrial fibrillation population: a modelling analysis based on a nationwide cohort study. Thromb Haemost 107(3):584–589PubMedGoogle Scholar
  23. 23.
    Coppens M, Hart RG, Eikelboom JW (2013) Stroke prevention in older adults with atrial fibrillation. CMAJ 19(17):1479–1480Google Scholar
  24. 24.
    Connolly SJ, Varrone J, Wang S et al (2009) Dabigatran versus warfarin in patients with atrial fibrillation. N Engl J Med 361(12):1139–1151PubMedGoogle Scholar
  25. 25.
    Patel MR, Piccini JP, Becker RC et al (2011) Rivaroxaban versus warfarin in nonvalvular atrial fibrillation. N Engl J Med 365(10):883–891PubMedGoogle Scholar
  26. 26.
    Granger CB, Avezum A, Bahit MC et al (2011) Apixaban versus warfarin in patients with atrial fibrillation. N Engl J Med 365(11):981–992PubMedGoogle Scholar
  27. 27.
    Giugliano RP, Ruff CT, Braunwald E et al (2013) Edoxaban versus warfarin in patients with atrial fibrillation. N Engl J Med 369(22):2093–2104PubMedGoogle Scholar
  28. 28.
    Lip GY (2011) The role of aspirin for stroke prevention in atrial fibrillation. Nat Rev Cardiol 8(10):602–606PubMedGoogle Scholar
  29. 29.
    Friberg L, Rosenqvist M, Lip GY (2012) Evaluation of risk stratification schemes for ischaemic stroke and bleeding in 182 678 patients with atrial fibrillation: the Swedish Atrial Fibrillation cohort study. Eur Heart J 33(12):1500–1510PubMedGoogle Scholar
  30. 30.
    Cabral KP (2013) Pharmacology of the new target-specific oral anticoagulants. J Thromb Thrombolysis 36(2):133–140PubMedGoogle Scholar
  31. 31.
    American public health association (2008) Strengthening health care systems in developing countries http://www.apha.org/advocacy/policy/policysearch/default.htm?id=1375.Accessed 25 December 2013
  32. 32.
    Barman D, Dutta A (2013) Access and barriers to immunization in West Bengal, India: quality matters. J Health Popul Nutr 31(4):510–522PubMedCentralPubMedGoogle Scholar
  33. 33.
    Izadnegahdar R, Cohen AL, Klugman KP et al (2013) Childhood pneumonia in developing countries. Lancet Respir Med 1(7):574–584PubMedGoogle Scholar
  34. 34.
    Mori AT, Kaale EA, Ngalesoni F et al (2014) The role of evidence in the decision-making process of selecting essential medicines in developing countries: the case of Tanzania. PLoS ONE 9(1):e84824PubMedCentralPubMedGoogle Scholar
  35. 35.
    Almaatouq MA, Al-Arouj M, Amod A et al (2014) Barriers to the delivery of optimal antidiabetic therapy in the Middle East and Africa. Int J Clin Pract 68(4):503–511PubMedGoogle Scholar
  36. 36.
    Singh P, Arrevad PS, Peterson GM et al (2011) Evaluation of antithrombotic usage for atrial fibrillation in aged care facilities. J Clin Pharm Ther 36(2):166–171PubMedGoogle Scholar
  37. 37.
    Bang A, McGrath NM (2011) The incidence of atrial fibrillation and the use of warfarin in Northland, New Zealand stroke patients. N Z Med J 124(1343):28–32PubMedGoogle Scholar
  38. 38.
    Mathur R, Pollara E, Hull S et al (2013) Ethnicity and stroke risk in patients with atrial fibrillation. Heart 99(15):1087–1092PubMedGoogle Scholar
  39. 39.
    Wilke T, Müller S (2012) PCV90 The quality of anticoagulation therapy in patients with atrial fibrillation. Value Health J Int Soc Pharmacoeconomics Outcome Res 15(4):A128Google Scholar
  40. 40.
    Aalbers J (2011) South Africa's poor warfarin control raises questions of benefit above other anticoagulant therapies in atrial fibrillation. Cardiovasc J Afr 22(4):220PubMedGoogle Scholar
  41. 41.
    Bronzetti GK, Corzani A, D'Angelo C et al (2012) Winning the war, far, in developing countries. Novel anticoagulants as a new weapon against stroke. Int J Cardiol 154(3):336–337PubMedGoogle Scholar
  42. 42.
    Anakwue RC, Ocheni SK, Madu JA (2011) The pattern and challenges of anticoagulation in a resource-constrained setting in Nigeria. J Clin Pharmacol 51:1352Google Scholar
  43. 43.
    Hylek EM, Go AS, Chang Y et al (2003) Effect of intensity of oral anticoagulation on stroke severity and mortality in atrial fibrillation. N Engl J Med 349(11):1019–1026PubMedGoogle Scholar
  44. 44.
    Casimire T, Carter R, Peters S et al (2008) Establishing an oral anticoagulant monitoring service in a multiethnic developing country. Int J Lab Hematol 30(6):531–535PubMedGoogle Scholar
  45. 45.
    Shrestha P, Koirala B, Shrestha N et al (2009) A study on complication and monitoring of warfarin in post-valve surgery. JNMA J Nepal Med Assoc 48(174):111–115PubMedGoogle Scholar
  46. 46.
    White HD, Gruber M, Feyzi J et al (2007) Comparison of outcomes among patients randomized to warfarin therapy according to anticoagulant control: results from SPORTIF III and V. Arch Intern Med 167(3):239–245PubMedGoogle Scholar
  47. 47.
    Shah SV, Gage BF (2011) Cost-effectiveness of dabigatran for stroke prophylaxis in atrial fibrillation. Circulation 123(22):2562–2570PubMedGoogle Scholar
  48. 48.
    Wallentin L, Yusuf S, Ezekowitz MD et al (2010) Efficacy and safety of dabigatran compared with warfarin at different levels of international normalised ratio control for stroke prevention in atrial fibrillation: an analysis of the RE-LY trial. Lancet 376(9745):975–983PubMedGoogle Scholar
  49. 49.
    Le Heuzey JY, Ammentorp B, Darius H et al. (2014) Differences among Western European countries in anticoagulation management of atrial fibrillation. Data from the PREFER IN AF Registry. Thromb Haemost 111 (5)Google Scholar
  50. 50.
    Rose AJ, Hylek EM, Ozonoff A et al (2011) Risk-adjusted percent time in therapeutic range as a quality indicator for outpatient oral anticoagulation: results of the Veterans Affairs Study to Improve Anticoagulation (VARIA). Circ Cardiovasc Qual Outcome 4(1):22–29Google Scholar
  51. 51.
    Connolly SJ, Pogue J, Eikelboom J et al (2008) Benefit of oral anticoagulant over antiplatelet therapy in atrial fibrillation depends on the quality of international normalized ratio control achieved by centers and countries as measured by time in therapeutic range. Circulation 118(20):2029–2037PubMedGoogle Scholar
  52. 52.
    Yan Xu AM, Christopher SS, Dar D, Ana P (2013) Prescribing patterns of novel oral anticoagulants following regulatory approval for atrial fibrillation in Ontario, Canada: a population-based descriptive analysis. CMAJ Open 1(3):E115–E119Google Scholar
  53. 53.
    Guo Y, Pisters R, Apostolakis S et al (2013) Stroke risk and suboptimal thromboprophylaxis in Chinese patients with atrial fibrillation: would the novel oral anticoagulants have an impact? Int J Cardiol 168(1):515–522PubMedGoogle Scholar
  54. 54.
    Yap LB, Rusani BI, Umadevan D et al. (2013) A single centre experience of the efficacy and safety of dabigatran etexilate used for stroke prevention in atrial fibrillation. J Thromb ThrombolysisGoogle Scholar
  55. 55.
    Bakker LE, Sleddering MA, Schoones JW et al (2013) Pathogenesis of type 2 diabetes in South Asians. Eur J Endocrinol 169(5):R99–R114PubMedGoogle Scholar
  56. 56.
    Hori M, Connolly SJ, Zhu J et al (2013) Dabigatran versus warfarin: effects on ischemic and hemorrhagic strokes and bleeding in Asians and non-Asians with atrial fibrillation. Stroke 44(7):1891–1896PubMedGoogle Scholar
  57. 57.
    Mishra P, Subish P, Upadhyay DK et al (2005) Medication counseling center in a teaching hospital. JNMA J Nepal Med Assoc 44(160):129–134PubMedGoogle Scholar
  58. 58.
    Bastakoti S, Khanal S, Dahal B et al (2013) Adherence and non-adherence to treatments: focus on pharmacy practice in Nepal. J Clin Diagn Res 7(4):754–757PubMedCentralPubMedGoogle Scholar
  59. 59.
    Palaian S, Poudel A, Alam K et al (2011) Initiation of social pharmacy research in Nepal: our experiences. Int J Clin Pharm 33(4):591–596PubMedGoogle Scholar
  60. 60.
    El-Gatit AM, Haw M (2003) Relationship between depression and non-adherence to anticoagulant therapy after valve replacement. East Mediterr Health J 9(1–2):12–19PubMedGoogle Scholar
  61. 61.
    Yi-Bing W, De-Gui K, Long-Le M et al (2013) Patient related factors for optimal blood pressure control in patients with hypertension. Afr Health Sci 13(3):579–583PubMedCentralPubMedGoogle Scholar
  62. 62.
    Ali F, Laurin MY, Lariviere C et al (2003) The effect of pharmacist intervention and patient education on lipid-lowering medication compliance and plasma cholesterol levels. Can J Clin Pharmacol 10(3):101–106PubMedGoogle Scholar
  63. 63.
    Fletcher J, Hogg W, Farrell B et al (2012) Effect of nurse practitioner and pharmacist counseling on inappropriate medication use in family practice. Can Fam Physician 58(8):862–868PubMedCentralPubMedGoogle Scholar
  64. 64.
    Liesenfeld KH, Lehr T, Dansirikul C et al (2011) Population pharmacokinetic analysis of the oral thrombin inhibitor dabigatran etexilate in patients with non-valvular atrial fibrillation from the RE-LY trial. J Thromb Haemost 9(11):2168–2175PubMedGoogle Scholar
  65. 65.
    Dansirikul C, Lehr T, Liesenfeld KH et al (2012) A combined pharmacometric analysis of dabigatran etexilate in healthy volunteers and patients with atrial fibrillation or undergoing orthopaedic surgery. Thromb Haemost 107(4):775–785PubMedGoogle Scholar
  66. 66.
    Stangier J (2008) Clinical pharmacokinetics and pharmacodynamics of the oral direct thrombin inhibitor dabigatran etexilate. Clin Pharmacokinet 47(5):285–295PubMedGoogle Scholar
  67. 67.
    Stangier J, Rathgen K, Stahle H et al (2007) The pharmacokinetics, pharmacodynamics and tolerability of dabigatran etexilate, a new oral direct thrombin inhibitor, in healthy male subjects. Br J Clin Pharmacol 64(3):292–303PubMedCentralPubMedGoogle Scholar
  68. 68.
    Samama MM, Amiral J, Guinet C et al (2010) An optimised, rapid chromogenic assay, specific for measuring direct factor Xa inhibitors (rivaroxaban) in plasma. Thromb Haemost 104(5):1078–1079PubMedGoogle Scholar
  69. 69.
    Barrett YC, Wang Z, Frost C et al (2010) Clinical laboratory measurement of direct factor Xa inhibitors: anti-Xa assay is preferable to prothrombin time assay. Thromb Haemost 104(6):1263–1271PubMedGoogle Scholar
  70. 70.
    Liesenfeld KH, Schafer HG, Troconiz IF et al (2006) Effects of the direct thrombin inhibitor dabigatran on ex vivo coagulation time in orthopaedic surgery patients: a population model analysis. Br J Clin Pharmacol 62(5):527–537PubMedCentralPubMedGoogle Scholar
  71. 71.
    Stangier J, Feuring M (2012) Using the HEMOCLOT direct thrombin inhibitor assay to determine plasma concentrations of dabigatran. Blood Coagul Fibrinolysis 23(2):138–143PubMedGoogle Scholar
  72. 72.
    Wong PC, Crain EJ, Xin B et al (2008) Apixaban, an oral, direct and highly selective factor Xa inhibitor: in vitro, antithrombotic and antihemostatic studies. J Thromb Haemost 6(5):820–829PubMedGoogle Scholar
  73. 73.
    Pastakia SD, Fohl AL, Schellhase EM et al (2010) Needs assessment analysis for vitamin K antagonist anticoagulation in the resource-constrained setting of Eldoret, Kenya. J Am Pharm Assoc (2003) 50(6):723–725Google Scholar
  74. 74.
    Majeed A, Hwang HG, Connolly SJ et al (2013) Management and outcomes of major bleeding during treatment with dabigatran or warfarin. Circulation 128(21):2325–2332PubMedGoogle Scholar
  75. 75.
    Heidbuchel H, Verhamme P, Alings M et al (2013) European Heart Rhythm Association Practical Guide on the use of new oral anticoagulants in patients with non-valvular atrial fibrillation. Europace 15(5):625–651PubMedGoogle Scholar
  76. 76.
    Ghosh S (2013) Unrestricted prescription of dabigatran: is it safe in a resource-limited setting. Indian J Crit Care Med 17(5):325–326PubMedCentralPubMedGoogle Scholar
  77. 77.
    Majeed A, Schulman S (2013) Bleeding and antidotes in new oral anticoagulants. Best Pract Res Clin Haematol 26(2):191–202PubMedGoogle Scholar
  78. 78.
    Schiele F, van Ryn J, Canada K et al (2013) A specific antidote for dabigatran: functional and structural characterization. Blood 121(18):3554–3562PubMedGoogle Scholar
  79. 79.
    Holster IL, Valkhoff VE, Kuipers EJ et al (2013) New oral anticoagulants increase risk for gastrointestinal bleeding: a systematic review and meta-analysis. Gastroenterology 145(1):105–112, e115PubMedGoogle Scholar
  80. 80.
    Kimmons LA, Kabra R, Davis M et al. (2013) Dabigatran use in the real world a multihospital system experience. J Pharm PractGoogle Scholar
  81. 81.
    Patidar D, Rajput MS, Nirmal NP et al (2013) Implementation and evaluation of adverse drug reaction monitoring system in a tertiary care teaching hospital in Mumbai, India. Interdiscip Toxicol 6(1):41–46PubMedCentralPubMedGoogle Scholar
  82. 82.
    Jha N, Shankar PR, Bajracharya O et al (2012) Adverse drug reaction reporting in a pharmacovigilance centre of Nepal. Australia Med J 5(5):268–271Google Scholar
  83. 83.
    Bista D, Shrestha BR, Rai P et al (2012) Pattern of adverse drug reactions reported to the regional pharmacovigilance center at Nepal Medical College and Teaching Hospital, Kathmandu. JNPA 26(1):54–61Google Scholar
  84. 84.
    Pisters R, Lane DA, Nieuwlaat R et al (2010) A novel user-friendly score (HAS-BLED) to assess 1-year risk of major bleeding in patients with atrial fibrillation: the Euro Heart Survey. Chest 138(5):1093–1100PubMedGoogle Scholar
  85. 85.
    Olsson SB (2003) Stroke prevention with the oral direct thrombin inhibitor ximelagatran compared with warfarin in patients with non-valvular atrial fibrillation (SPORTIF III): randomised controlled trial. Lancet 362(9397):1691–1698PubMedGoogle Scholar
  86. 86.
    Halperin JL (2003) Ximelagatran compared with warfarin for prevention of thromboembolism in patients with nonvalvular atrial fibrillation: rationale, objectives, and design of a pair of clinical studies and baseline patient characteristics (SPORTIF III and V). Am Heart J 146(3):431–438PubMedGoogle Scholar
  87. 87.
    Albers GW, Diener HC, Frison L et al (2005) Ximelagatran vs warfarin for stroke prevention in patients with nonvalvular atrial fibrillation: a randomized trial. JAMA 293(6):690–698PubMedGoogle Scholar
  88. 88.
    Lip GYH, Frison L, Halperin JL et al (2011) Comparative validation of a novel risk score for predicting bleeding risk in anticoagulated patients with atrial fibrillation. J Am Coll Cardiol 57(2):173–180PubMedGoogle Scholar
  89. 89.
    Guo Y, Lip GY, Apostolakis S (2013) Bleeding risk assessment in patients with atrial fibrillation who are taking oral anticoagulants. Hosp Pract (1995) 41(1):71–78Google Scholar
  90. 90.
    Agarwal MB, Verma S, Mahapatra M et al (2012) Balancing efficacy and bleeding risk in the prevention of stroke due to atrial fibrillation with newer oral anticoagulants. Indian J Hematol Blood Transf 28(3):129–143Google Scholar
  91. 91.
    Li F, Cai Y, Zhu Y et al (2013) The evaluation of general practitioners' awareness/knowledge and adherence to the GOLD Guidelines in a Shanghai suburb. J Public Health, Asia PacGoogle Scholar
  92. 92.
    Kornej J, Potpara T, Lip GY (2013) Anticoagulation management in non-valvular atrial fibrillation: current and future directions. Pol Arch Med Wewn 123(11):623–634PubMedGoogle Scholar
  93. 93.
    Deyell MW, Cox JL, Bennett MT et al (2013) Adopting the new anticoagulants: all aboard or all in good time? Can J Cardiol 29(10):1295–1298PubMedGoogle Scholar
  94. 94.
    Sorensen R, Gislason G, Torp-Pedersen C et al. (2013) Dabigatran use in Danish atrial fibrillation patients in 2011: a nationwide study. BMJ Open 3 (5)Google Scholar
  95. 95.
    Apostolakis S, Sullivan RM, Olshansky B et al (2013) Factors affecting quality of anticoagulation control among patients with atrial fibrillation on warfarin: the SAMe-TT2R2 score. Chest 144(5):1555–1563PubMedGoogle Scholar
  96. 96.
    Boriani G (2013) Predicting the quality of anticoagulation during warfarin therapy: the basis for an individualized approach. Chest 144(5):1437–1438PubMedGoogle Scholar
  97. 97.
    Bista D, Saha A, Mishra P et al (2009) Impact of an educational intervention on the pattern and incidence of potential drug–drug interactions in Nepal. Pharm Pract (Internet) 7(4):242–247Google Scholar
  98. 98.
    Dinesh KU, Subish P, Pranaya M et al (2007) Pattern of potential drug–drug interactions in diabetic out-patients in a tertiary care teaching hospital in Nepal. Med J Malays 62(4):294–298Google Scholar
  99. 99.
    Mateti U, Rajakannan T, Nekkanti H et al (2011) Drug–drug interactions in hospitalized cardiac patients. J Young Pharm 3(4):329–333PubMedCentralPubMedGoogle Scholar
  100. 100.
    Mishra D, Paudel R, Kishore P et al (2007) Interaction between warfarin and tamoxifen: a case report. Kathmandu Univ Med J (KUMJ) 5(1):105–107Google Scholar
  101. 101.
    Bavle AD, Phatak AS (2013) Bupropion–warfarin combination: a serious complication. Indian J Psychol Med 35 (3):311–313Google Scholar
  102. 102.
    Njovane XW, Fasinu PS, Rosenkranz B (2013) Comparative evaluation of warfarin utilisation in two primary healthcare clinics in the Cape Town area. Cardiovasc J Afr 24(2):19–23PubMedCentralPubMedGoogle Scholar
  103. 103.
    Lane MA, Zeringue A, McDonald JR (2014) Serious bleeding events due to warfarin and antibiotic co-prescription in a cohort of veterans. Am J MedGoogle Scholar
  104. 104.
  105. 105.
    Xarelto PI (2013) Available at: http://www.bayerresources.com.au/resources/uploads/PI/file9466.pdf. Accessed April 9, 2014
  106. 106.
    Eliquis-Bristol-Myers Squidd (2014) Available at: http://packageinserts.bms.com/pi/pi_eliquis.pdf. Accessed April 9, 2014
  107. 107.
    Weinz C, Buetehorn U, Daehler HP et al (2005) Pharmacokinetics of BAY 59–7939–an oral, direct Factor Xa inhibitor–in rats and dogs. Xenobiotica 35(9):891–910PubMedGoogle Scholar
  108. 108.
    Verma SC, Dhungana GP, Joshi HS et al (2012) Prevalence of pulmonary tuberculosis among HIV infected persons in Pokhara, Nepal. J Nepal Health Res Counc 10(1):32–36PubMedGoogle Scholar
  109. 109.
    Kandi S, Prasad SV, Sagar Reddy PN et al (2013) Prevalence of multidrug resistance among retreatment pulmonary tuberculosis cases in a tertiary care hospital, Hyderabad, India. Lung India 30(4):277–279PubMedCentralPubMedGoogle Scholar
  110. 110.
    Sawicka-Powierza J, Rogowska-Szadkowska D, Oltarzewska AM et al (2008) Factors influencing activity of oral anticoagulants. Interactions with drugs and food. Pol Merkur Lekarski 24(143):458–462PubMedGoogle Scholar
  111. 111.
    Eikelboom JW, Connolly SJ, Brueckmann M et al (2013) Dabigatran versus warfarin in patients with mechanical heart valves. N Engl J Med 369(13):1206–1214PubMedGoogle Scholar
  112. 112.
    Kolias TJ (2013) Dabigatran increased bleeding and stroke compared with warfarin after mechanical heart valve implantation. Ann Intern Med 159(12):JC6PubMedGoogle Scholar
  113. 113.
    Atar S, Wishniak A, Shturman A et al (2013) Fatal association of mechanical valve thrombosis with dabigatran: a report of two cases. Chest 144(1):327–328PubMedGoogle Scholar
  114. 114.
    Kuwauchi S, Watanabe S, Abe K et al (2013) Thromboembolism in a patient with a mechanical mitral valve during anticoagulation with dabigatran etexilate. Ann Thorac Surg 96(5):1863–1864PubMedGoogle Scholar
  115. 115.
    Hylek EM (2013) Dabigatran and mechanical heart valves—not as easy as we hoped. N Engl J Med 369(13):1264–1266PubMedGoogle Scholar
  116. 116.
    Loke YK, Pradhan S, Yeong JK et al. (2014) Comparative coronary risks of apixaban, rivaroxaban and dabigatran: a meta-analysis and adjusted indirect comparison. Br J Clin PharmacolGoogle Scholar
  117. 117.
    Artang R, Rome E, Nielsen JD et al (2013) Meta-analysis of randomized controlled trials on risk of myocardial infarction from the use of oral direct thrombin inhibitors. Am J Cardiol 112(12):1973–1979PubMedGoogle Scholar
  118. 118.
    Limone BL, Baker WL, Kluger J et al (2013) Novel anticoagulants for stroke prevention in atrial fibrillation: a systematic review of cost-effectiveness models. PLoS ONE 8(4):e62183PubMedCentralPubMedGoogle Scholar
  119. 119.
    Harris K, Mant J (2013) Potential impact of new oral anticoagulants on the management of atrial fibrillation-related stroke in primary care. Int J Clin Pract 67(7):647–655PubMedCentralPubMedGoogle Scholar
  120. 120.
    Sorensen SV, Kansal AR, Connolly S et al (2011) Cost-effectiveness of dabigatran etexilate for the prevention of stroke and systemic embolism in atrial fibrillation: a Canadian payer perspective. Thromb Haemost 105(5):908–919PubMedGoogle Scholar
  121. 121.
    Freeman JV, Zhu RP, Owens DK et al (2011) Cost-effectiveness of dabigatran compared with warfarin for stroke prevention in atrial fibrillation. Ann Intern Med 154(1):1–11PubMedGoogle Scholar
  122. 122.
    Wouters H, Thijs V, Annemans L (2013) Cost-effectiveness of dabigatran etexilate in the prevention of stroke and systemic embolism in patients with atrial fibrillation in Belgium. J Med Econ 16(3):407–414PubMedGoogle Scholar
  123. 123.
    McKeage K (2012) Dabigatran etexilate: a pharmacoeconomic review of its use in the prevention of stroke and systemic embolism in patients with atrial fibrillation. Pharmacoeconomics 30(9):841–855PubMedGoogle Scholar
  124. 124.
    Kansal AR, Sorensen SV, Gani R et al (2012) Cost-effectiveness of dabigatran etexilate for the prevention of stroke and systemic embolism in UK patients with atrial fibrillation. Heart 98(7):573–578PubMedCentralPubMedGoogle Scholar
  125. 125.
    Wu B, Kun L, Liu X et al (2013) Cost-effectiveness of different strategies for stroke prevention in patients with atrial fibrillation in a health resource-limited setting. Cardiovasc Drugs Ther 28(1):87–98Google Scholar
  126. 126.
    Riva N, Lip GY (2012) A new era for anticoagulation in atrial fibrillation. Which anticoagulant should we choose for longterm prevention of thromboembolic complications in patients with atrial fibrillation? Pol Arch Med Wewn 122(1–2):45–53PubMedGoogle Scholar
  127. 127.
    Burnett A, Tiongson J, Downey R et al (2013) The hidden costs of anticoagulation in hospitalized patients with non-valvular atrial fibrillation. Expert Opin Pharmacother 14(9):1119–1133PubMedGoogle Scholar
  128. 128.
    Kasmeridis C, Apostolakis S, Ehlers L et al (2013) Cost effectiveness of treatments for stroke prevention in atrial fibrillation: focus on the novel oral anticoagulants. Pharmacoeconomics 31(11):971–980PubMedGoogle Scholar
  129. 129.
    Elewa HF, Deremer CE, Keller K et al. (2013) Patients satisfaction with warfarin and willingness to switch to dabigatran: a patient survey. J Thromb ThrombolysisGoogle Scholar
  130. 130.
    Thavorncharoensap M, Teerawattananon Y, Natanant S et al (2013) Estimating the willingness to pay for a quality-adjusted life year in Thailand: does the context of health gain matter? Clinicoecon Outcome Res 5:29–36Google Scholar
  131. 131.
    Zhao FL, Yue M, Yang H et al (2011) Willingness to pay per quality-adjusted life year: is one threshold enough for decision-making?: results from a study in patients with chronic prostatitis. Med Care 49(3):267–272PubMedGoogle Scholar
  132. 132.
    Malmstrom RE, Godman BB, Diogene E et al (2013) Dabigatran—a case history demonstrating the need for comprehensive approaches to optimize the use of new drugs. Front Pharmacol 4:39PubMedCentralPubMedGoogle Scholar
  133. 133.
    Ansell J, Hirsh J, Dalen J et al. (2001) Managing oral anticoagulant therapy. Chest 119 (1_suppl):22S-38SGoogle Scholar
  134. 134.
    Chan FW, Wong RS, Lau WH et al (2006) Management of Chinese patients on warfarin therapy in two models of anticoagulation service—a prospective randomized trial. Br J Clin Pharmacol 62(5):601–609PubMedCentralPubMedGoogle Scholar
  135. 135.
    Jackson SL, Peterson GM, House M et al (2004) Point-of-care monitoring of anticoagulant therapy by rural community pharmacists: description of successful outcomes. Aust J Rural Health 12(5):197–200PubMedGoogle Scholar
  136. 136.
    Jackson SL, Peterson GM, Vial JH et al (2004) Improving the outcomes of anticoagulation: an evaluation of home follow-up of warfarin initiation. J Intern Med 256(2):137–144PubMedGoogle Scholar
  137. 137.
    Gill JM, Landis MK (2002) Benefits of a mobile, point-of-care anticoagulation therapy management program. Jt Comm J Qual Improv 28(11):625–630PubMedGoogle Scholar
  138. 138.
    Gallego P, Roldan V, Lip GY (2013) Novel oral anticoagulants in cardiovascular disease. J Cardiovasc Pharmacol Ther 19(1):34–44PubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Durga Bista
    • 1
  • Leanne Chalmers
    • 1
  • Luke Bereznicki
    • 1
  • Gregory Peterson
    • 1
  1. 1.Pharmacy, School of MedicineUniversity of TasmaniaHobartAustralia

Personalised recommendations