Atrial fibrillation (AF) is a major cause of stroke. To prevent this devastating complication, anticoagulants are recommended in some patients. Two classes of oral anticoagulants can be used for this indication: anti-vitamin K (AVK) agents, such as warfarin, and direct-acting non-vitamin K oral anticoagulants, also called new oral anticoagulants (NOACs). NOACs include agents with two distinct modes of action: direct factor Xa inhibitors (apixaban, rivaroxaban, edoxaban) on the one hand and direct thrombin inhibitors (dabigatran) on the other hand. These molecules have been compared individually to warfarin: While showing similar efficacy, they had a better safety profile in terms of bleeding, with a lower risk of hemorrhagic stroke and intracranial hemorrhage. They are therefore preferred over AVKs.

The choice of the anticoagulant is made on a case-by-case basis, always taking into account the risk of stroke (using anticoagulants in patients without thromboembolic risk factors is currently not recommended) and bleeding (dosage!). These two aspects should be assessed prior to any prescription. When choosing an anticoagulant agent, the physician should also consider the presence of coronary artery disease (concomitant use of antiplatelet therapy), the patient's age and weight (dose adjustment!), renal function (important for dabigatran), the patient’s preference (once daily vs twice daily administration), and the patient’s understanding of the treatment, which is decisive for therapeutic compliance. It should be noted that dabigatran is currently the only NOAC for which a specific reversal agent is available that can be used in some cases when emergency surgery is required or major bleeding has to be controlled.

Psoriasis, a very common systemic inflammatory disease, is potentially disabling from a functional and aesthetic point of view. In recent years, treatments for managing moderate- to-severe psoriasis have significantly evolved since the advent of biologic therapies. Undoubtedly, these latter have favorably impacted the patient quality of life.

The CREDENCE study sought to compare the efficacy of canagliflozin vs. placebo in preventing clinically-relevant kidney and cardiovascular events in patients with diabetes and established kidney disease. With regard to the primary endpoint (terminal kidney failure; doubling of creatinine; renal or cardiovascular death), the authors reported a 30% reduction in the relative risk (hazard ratio [HR]: 0.70; 95% CI: 0.59-0.82, p=0.00001) after 2.6 years of follow-up. The risk was reduced by 17-39% with regard to secondary cardiovascular or renal endpoints. These results should be integrated in our therapeutic approach for Type 2 diabetes patients, in terms of both nephro- and cardioprotection.