Management of Patients Treated with Direct Oral Anticoagulants in Clinical Practice and Challenging Scenarios

It is well established that direct oral anticoagulants (DOACs) are the cornerstone of anticoagulant strategy in atrial fibrillation (AF) and venous thromboembolism (VTE) and should be preferred over vitamin K antagonists (VKAs) since they are superior or non-inferior to VKAs in reducing thromboembol...

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Published in:Journal of clinical medicine 2023-09, Vol.12 (18), p.5955
Main Authors: Lucà, Fabiana, Oliva, Fabrizio, Abrignani, Maurizio Giuseppe, Di Fusco, Stefania Angela, Parrini, Iris, Canale, Maria Laura, Giubilato, Simona, Cornara, Stefano, Nesti, Martina, Rao, Carmelo Massimiliano, Pozzi, Andrea, Binaghi, Giulio, Maloberti, Alessandro, Ceravolo, Roberto, Bisceglia, Irma, Rossini, Roberta, Temporelli, Pier Luigi, Amico, Antonio Francesco, Calvanese, Raimondo, Gelsomino, Sandro, Riccio, Carmine, Grimaldi, Massimo, Colivicchi, Furio, Gulizia, Michele Massimo
Format: Article
Language:English
Subjects:
Anticoagulants
Anticoagulants (Medicine)
Cancer therapies
Cardiac arrhythmia
Care and treatment
Clinical medicine
Clopidogrel
Complications and side effects
Cytochrome
Dabigatran etexilate
Dosage and administration
Drug interactions
Drugs
Enzymes
Health aspects
Hemorrhage
Liver
Liver diseases
Metabolism
Pharmacodynamics
Pharmacokinetics
Plasma
Prescribing
Review
Risk factors
Thromboembolism
Ticagrelor
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Summary:It is well established that direct oral anticoagulants (DOACs) are the cornerstone of anticoagulant strategy in atrial fibrillation (AF) and venous thromboembolism (VTE) and should be preferred over vitamin K antagonists (VKAs) since they are superior or non-inferior to VKAs in reducing thromboembolic risk and are associated with a lower risk of intracranial hemorrhage (IH). In addition, many factors, such as fewer pharmacokinetic interactions and less need for monitoring, contribute to the favor of this therapeutic strategy. Although DOACs represent a more suitable option, several issues should be considered in clinical practice, including drug-drug interactions (DDIs), switching to other antithrombotic therapies, preprocedural and postprocedural periods, and the use in patients with chronic renal and liver failure and in those with cancer. Furthermore, adherence to DOACs appears to remain suboptimal. This narrative review aims to provide a practical guide for DOAC prescription and address challenging scenarios.
ISSN:2077-0383
2077-0383
DOI:10.3390/jcm12185955