Direct Oral Anticoagulant Agents: Pharmacologic Profile, Indications, Coagulation Monitoring, and Reversal Agents

Journal of Stroke and Cerebrovascular Diseases : the Official Journal of National Stroke Association
Deborah K Rose, Barak Bar

Abstract

Vitamin K antagonists (VKAs), such as warfarin, have been used for thromboprophylaxis and for the treatment of thromboembolic events in patients with nonvalvular atrial fibrillation for over 60 years. The increasing use of direct oral anticoagulants (DOACs) in recent years has shown greater advantages and safer use over VKA, including reduced bleeding, fewer drug interactions, no food interactions, a quick onset and offset of activity, and predictable dose-response properties. Despite their advantages, there are a couple of major limitations that raise concerns among clinicians, including the need for more coagulation assays to monitor their effects and more specific reversal antidotes in life-threatening circumstances of bleeding. This review will discuss the important characteristics of the 5 Food and Drug Administration-approved DOACs (including anticoagulation monitoring for each) and the specific and nonspecific reversal agents to DOAC-associated bleeding.

Citations

Sep 15, 2018·Xenobiotica; the Fate of Foreign Compounds in Biological Systems·Miho Yamazaki-NishiokaHiroshi Yamazaki
Dec 21, 2018·Therapeutic Drug Monitoring·Eberhard Wieland, Maria Shipkova
Jun 17, 2020·Journal of the American Heart Association·Ashley ChenBruce A Warden
Mar 19, 2019·Therapeutic Drug Monitoring·Eberhard Wieland, Maria Shipkova
Aug 18, 2020·International Journal of General Medicine·Hisham A BadreldinMohamed Salih Aziz Mohamed
Mar 12, 2021·International Journal of Cardiology·Doris BarcellonaFrancesco Marongiu
Oct 16, 2021·Internal and Emergency Medicine·Andrew Tiger ChenJames Demetrios Douketis

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