An Update on the "Novel" and Direct Oral Anticoagulants, and Long-Term Anticoagulant Therapy

Mia Djulbegovic; Alfred Ian Lee

doi:10.1016/j.ccm.2018.04.010

An Update on the "Novel" and Direct Oral Anticoagulants, and Long-Term Anticoagulant Therapy

Clin Chest Med. 2018 Sep;39(3):583-593. doi: 10.1016/j.ccm.2018.04.010.

Authors

Mia Djulbegovic¹, Alfred Ian Lee²

Affiliations

¹ Traditional Internal Medicine Residency Program, Department of Internal Medicine, Yale School of Medicine, 333 Cedar Street, New Haven, CT 06520, USA.
² Section of Hematology, Department of Internal Medicine, Yale School of Medicine, 333 Cedar Street, New Haven, CT 06520, USA. Electronic address: alfred.lee@yale.edu.

PMID: 30122182
DOI: 10.1016/j.ccm.2018.04.010

Abstract

The mainstay of treatment of venous thromboembolism (VTE) is anticoagulation. Direct oral anticoagulants (DOAC) have revolutionized anticoagulation management, although their efficacy and safety in specialized populations such as antiphospholipid syndrome, advanced renal disease, cancer thrombosis, and geriatric patients remain uncertain. Concerns about bleeding risks of DOACs persist despite reassuring data in the literature and the development of specific antidotes. In this article, the authors present an overview of the basic pharmacology of DOACs and discuss their use in acute VTE, secondary VTE prevention, and specialized VTE patient populations and discuss therapeutic monitoring and reversal in the event of major bleeding.

Keywords: Andexanet-alfa; Anti-Xa level; CYP3A4; Direct oral anticoagulant (DOAC); Idarucizumab; P-glycoprotein transport; Thrombin time; Venous thromboembolism.

Publication types

Review

MeSH terms

Administration, Oral
Anticoagulants / pharmacology
Anticoagulants / therapeutic use*
Humans
Venous Thromboembolism / drug therapy*

Substances

Anticoagulants