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VOLUME 17 NUMBER 1 • JULY 2020
37
SA JOURNAL OF DIABETES & VASCULAR DISEASE
CASE REPORT
inclusion criteria and the results of the trials of these agents, we can
conclude that as a group they are as effective as or more effective
than warfarin at preventing stroke, and all have a lower risk of
brain bleeding. Because there is little difference in their respective
costs, personal preference, tolerability and ease of dosing play a
role when deciding which NOAC to prescribe.
Is there a treatment that could offer benefits beyond stroke prevention
in this case?
A.
Yes
B.
No
Expert comment
In his presentation, Professor Patel included observational data on the effects
of NOACs in preventing acute kidney injury and progression to end-stage
kidney failure, as well as the reduction of revascularisation and amputations
in peripheral arterial disease. Observational data do not carry the same weight
as the results of a randomised clinical trial; these results strongly suggest that
when dealing with patients who have diabetes and NVAF, specific NOACs
should be the drug of choice for those with cardiovascular disease, impaired
kidney function and/or evidence of peripheral arterialdisease.
In diabetes and NVAF, a NOAC should be preferred in the
following settings:
• Established cardiovascular disease
• Chronic kidney injury
• Peripheral arterial disease
valvular atrial fibrillation in Germany - A retrospective cohort study.
Int J Cardiol
Heart Vasc
2019;
23
: 100367.
10. Hernandez AV, Bradley G, Kahn M,
et al.
Rivaroxaban versus warfarin and renal
outcomes in non-valvular atrial fibrillation patients with diabetes.
Eur Heart J Qual
Care Clin Outcomes
2019; pii: qcz047.
11. Tonelli M, Muntner P, Lloyd A,
et al
. Risk of coronary events in people with chronic
kidney disease compared with those with diabetes: a population-level cohort
study.
Lancet
2012;
380
(9844): 807-814.
12. Connolly SJ, Ezekowitz MD, Yusuf S,
et al
. Dabigatran versus warfarin in patients
with atrial fibrillation.
N Engl J Med
2009;
361
: 1139-1151.
13. Baker WL, Beyer-Westendorf J, Bunz TJ,
et al.
Effectiveness and safety of
rivaroxaban and warfarin for prevention of major adverse cardiovascular or
limb events in patients with non-valvular atrial fibrillation and type 2 diabetes.
Diabetes Obes Metab
2019;
21
(9): 2107-2114.
Acknowledgement
This report was made possible by an unrestricted educational grant
from Bayer. The content of the report is independent of the sponsor.
References
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Eur Heart J
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8. Choe WS, Choi EK, Han KD,
et al.
Association of metabolic syndrome and chronic
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9. Bonnemeier H, Huelsebeck M, Kloss S. Comparative effectiveness of rivaroxaban
versus a vitamin K antagonist in patients with renal impairment treated for non-
MA-M_ZA-0044-1
DYNAFIL 50, 100 mg.
Each tablet contains sildenafil citrate equivalent to 50, 100 mg sildenafil respectively.
S4 A42/7.1.5/1071, 1072. NAM NS2 13/7.1.5/0086, 0087. For full prescribing information, refer to the
professional information approved by SAHPRA, September 2012.
DLB562/05/2020
.
CUSTOMER CARE LINE
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www.pharmadynamics.co.zaSILDENAFIL 50 mg•100 mg
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PACKED IN A
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Give them one less
thing to stress about.
It’s time
we talk
about ED