Direct Oral Anticoagulant Use: A Practical Guide to Common Clinical Challenges

Direct oral anticoagulants (DOACs) have quickly become attractive alternatives to the long-standing standard of care in anticoagulation, vitamin K antagonist. DOACs are indicated for prevention and treatment of several cardiovascular conditions. Since the first approval in 2010, DOACs have emerged a...

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Published inJournal of the American Heart Association Vol. 9; no. 13; p. e017559
Main Authors Chen, Ashley, Stecker, Eric, A Warden, Bruce
Format Journal Article
LanguageEnglish
Published England John Wiley and Sons Inc 07.07.2020
Wiley
Subjects
Administration, Oral
anticoagulation
Blood Coagulation - drug effects
Clinical Decision-Making
Comorbidity
Contemporary Review
Contemporary Reviews
Cost-Benefit Analysis
Drug Costs
Drug Interactions
Drug Monitoring
Drug Substitution
Factor Xa Inhibitors - adverse effects
Factor Xa Inhibitors - economics
Factor Xa Inhibitors - pharmacokinetics
Factor Xa Inhibitors - therapeutic use
Hemorrhage - chemically induced
Humans
oral direct thrombin inhibitor
oral factor Xa inhibitors
pharmacotherapy
Risk Assessment
Risk Factors
Treatment Outcome
oral direct thrombin inhibitor
oral factor Xa inhibitors
pharmacotherapy
anticoagulation
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Summary:Direct oral anticoagulants (DOACs) have quickly become attractive alternatives to the long-standing standard of care in anticoagulation, vitamin K antagonist. DOACs are indicated for prevention and treatment of several cardiovascular conditions. Since the first approval in 2010, DOACs have emerged as leading therapeutic alternatives that provide both clinicians and patients with more effective, safe, and convenient treatment options in thromboembolic settings. With the expanding role of DOACs, clinicians are faced with increasingly complex decisions relating to appropriate agent, duration of treatment, and use in special populations. This review will provide an overview of DOACs and act as a practical reference for clinicians to optimize DOAC use among common challenging scenarios. Topics addressed include (1) appropriate indications; (2) use in patients with specific comorbidities; (3) monitoring parameters; (4) transitioning between anticoagulant regimens; (5) major drug interactions; and (6) cost considerations.
Bibliography:For Sources of Funding and Disclosures, see page 15.
ISSN:2047-9980
2047-9980
DOI:10.1161/jaha.120.017559