학술논문
Management of Patients Treated with Direct Oral Anticoagulants in Clinical Practice and Challenging Scenarios
Document Type
Academic Journal
Author
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
Source
Journal of Clinical Medicine. September 2023, Vol. 12 Issue 18
Subject
Language
English
ISSN
2077-0383
Abstract
Author(s): Fabiana Lucà (corresponding author) [1,*,†]; Fabrizio Oliva [2]; Maurizio Giuseppe Abrignani [3,‡]; Stefania Angela Di Fusco [4,§]; Iris Parrini [5]; Maria Laura Canale [6,‖]; Simona Giubilato [7,†]; Stefano Cornara [...]
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.
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.