RT Journal Article
SR Electronic
T1 Direct oral anticoagulants: unique properties and practical approaches to management
JF Heart
JO Heart
FD BMJ Publishing Group Ltd and British Cardiovascular Society
SP 1620
OP 1626
DO 10.1136/heartjnl-2015-309075
VO 102
IS 20
A1 Geoffrey D Barnes
A1 Brian Kurtz
YR 2016
UL http://heart.bmj.com/content/102/20/1620.abstract
AB Since 2009, four direct oral anticoagulants (DOACs) have been introduced for treatment of venous thromboembolism and stroke prevention in non-valvular atrial fibrillation. While they are currently first-line therapy for a majority of patients, there are a number of clinical situations where warfarin is preferable. In both randomised trials and real-world populations, use of DOACs significantly reduces the risk of intracranial haemorrhage as compared with warfarin. While drug-specific reversal agents are currently only available for dabigatran, andexanet alpha is pending approval for reversal of factor Xa inhibitors, reducing concerns about major bleeding for many patients and providers. DOACs can be held for 2–4 days prior to a procedure, depending on a patient’s renal function, but should not be restarted too rapidly post-procedurally given their fast time to peak activity (∼2 hours). The anticoagulation clinic should play an important role in managing patients on all oral anticoagulation, both warfarin and DOACs.