Expert Recommendations on the Usage of Non-vitamin K Antagonist Oral Anticoagulants (NOACs) from India: Current Perspective and Future Direction

Figures

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  Fig. 1. Initial treatment of VTE [17]. CKD chronic kidney disease, LMWH low molecular weight heparin

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  Fig. 2. Dose regimens of the NOACs (based on the EU labels) for the treatment of VTE [25]. OD once-daily, BD twice-daily, CrCl creatinine clearance

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  Fig. 3. Selection of stroke-prevention therapies in patients with non-valvular atrial fibrillation (NVAF) and risk factors based on the CHA2DS2‐VASc score [41]. *Uncontrolled hypertension, labile INRs, concomitant aspirin/NSAID use, alcohol excess. VKA vitamin K antagonist, INR international normalized ratio, NSAID non-steroidal anti-inflammatory drug, OAC oral anticoagulant, TTR time in therapeutic range. Antiplatelet therapy with aspirin-clopidogrel or—less effectively—aspirin monotherapy (consider only in patients who are unwilling or unable to take any form of OAC whether VKA or NOAC)

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  Fig. 4. Post-procedural management of patients with AF and ACS/PCI [42]. Full-outlined arrows—default strategy; dashed arrows—treatment modifications. ACS acute coronary syndromes, ASA acetylsalicylic acid, CAD coronary artery disease, CCS chronic coronary syndromes, CKD chronic kidney disease, DAPT dual antithrombotic therapy, eGFR estimated glomerular filtration rate, ICH intracranial hemorrhage, INR international normalized ratio, LMWH low molecular weight heparin, MI myocardial infarction, NOAC non-vitamin K antagonist oral anticoagulant, NSAID non-steroidal anti-inflammatory drug, OAC oral anticoagulant, PAD peripheral artery disease, PCI percutaneous coronary intervention, PPI proton-pump inhibitor, STEMI ST-segment elevation myocardial infarction, UFH unfractionated heparin, VKA vitamin K antagonist

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  Fig. 5. Stepwise approach to initiate NOAC while on DAPT [50]. *Stent under-expansion, significant edge dissection or residual reference segment disease. DAPT dual antiplatelet therapy, DES drug-eluting stent, IVUS intravascular ultrasound, NOAC novel oral anticoagulant, OAC oral anticoagulant, OCT optical coherence tomography, PCI percutaneous coronary intervention

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  Fig. 6. Timing for interruption of a NOAC before and after elective surgery [71]. *Regular NOAC dose. Note: ✔ indicates continue NOAC; ✖ indicates stopping NOAC

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  Fig. 7. Management of active bleeding in patients receiving NOAC anticoagulation [42]. FFP fresh frozen plasma, INR international normalized ratio, i.v. intravenous, NOAC non-vitamin K antagonist oral anticoagulant, OAC oral anticoagulation therapy, PCC prothrombin complex concentrates, VKA vitamin K antagonist

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  Fig. 8. Dosing regimen of NOAC reversal agents [72]