TY - JOUR
T1 - The Non-Vitamin K Antagonist Oral Anticoagulants in Heart Disease
T2 - Section V-Special Situations
AU - De Caterina, Raffaele
AU - Ageno, Walter
AU - Agnelli, Giancarlo
AU - Chan, Noel C
AU - Diener, Hans-Christoph
AU - Hylek, Elaine
AU - Raskob, Gary E
AU - Siegal, Deborah M
AU - Verheugt, Freek W A
AU - Lip, Gregory Y H
AU - Weitz, Jeffrey I
PY - 2019/1
Y1 - 2019/1
N2 - Non-vitamin K antagonist oral anticoagulants (NOACs) include dabigatran, which inhibits thrombin, and apixaban, betrixaban, edoxaban and rivaroxaban, which inhibit factor Xa. In large clinical trials comparing the NOACs with the vitamin K antagonist (VKA) warfarin, dabigatran, apixaban, rivaroxaban and edoxaban were at least as effective for stroke prevention in atrial fibrillation and for treatment of venous thromboembolism, but were associated with less intracranial bleeding. In addition, the NOACs are more convenient to administer than VKAs because they can be given in fixed doses without routine coagulation monitoring. Consequently, the NOACs are now replacing VKAs for these indications, and their use is increasing. Although, as a class, the NOACs have a favourable benefit-risk profile compared with VKAs, choosing among them is complicated because they have not been compared in head-to-head trials. Therefore, selection depends on the results of the individual trials, renal function, the potential for drug-drug interactions and preference for once- or twice-daily dosing. In addition, several 'special situations' were not adequately studied in the dedicated clinical trials. For these situations, knowledge of the unique pharmacological features of the various NOACs and judicious cross-trial comparison can help inform prescription choices. The purpose of this position article is therefore to help clinicians choose the right anticoagulant for the right patient at the right dose by reviewing a variety of special situations not widely studied in clinical trials.
AB - Non-vitamin K antagonist oral anticoagulants (NOACs) include dabigatran, which inhibits thrombin, and apixaban, betrixaban, edoxaban and rivaroxaban, which inhibit factor Xa. In large clinical trials comparing the NOACs with the vitamin K antagonist (VKA) warfarin, dabigatran, apixaban, rivaroxaban and edoxaban were at least as effective for stroke prevention in atrial fibrillation and for treatment of venous thromboembolism, but were associated with less intracranial bleeding. In addition, the NOACs are more convenient to administer than VKAs because they can be given in fixed doses without routine coagulation monitoring. Consequently, the NOACs are now replacing VKAs for these indications, and their use is increasing. Although, as a class, the NOACs have a favourable benefit-risk profile compared with VKAs, choosing among them is complicated because they have not been compared in head-to-head trials. Therefore, selection depends on the results of the individual trials, renal function, the potential for drug-drug interactions and preference for once- or twice-daily dosing. In addition, several 'special situations' were not adequately studied in the dedicated clinical trials. For these situations, knowledge of the unique pharmacological features of the various NOACs and judicious cross-trial comparison can help inform prescription choices. The purpose of this position article is therefore to help clinicians choose the right anticoagulant for the right patient at the right dose by reviewing a variety of special situations not widely studied in clinical trials.
KW - NOACs
KW - non-vitamin K antagonist oral anticoagulants
KW - oral anticoagulants
KW - special situations
UR - http://www.scopus.com/inward/record.url?scp=85059291684&partnerID=8YFLogxK
U2 - 10.1055/s-0038-1675816
DO - 10.1055/s-0038-1675816
M3 - Review article
C2 - 30597497
SN - 0340-6245
VL - 119
SP - 14
EP - 38
JO - Thrombosis and Haemostasis
JF - Thrombosis and Haemostasis
IS - 1
ER -