Is there a role for pharmacokinetic/pharmacodynamic-guided dosing for novel oral anticoagulants?

American Heart Journal
Noel ChanJonathan H Seltzer

Abstract

The novel direct oral anticoagulants (NOACs) represent a major advance in oral anticoagulant therapy and are replacing vitamin K antagonists as the preferred options for many indications. Given in fixed doses without routine laboratory monitoring, they have been shown to be at least as effective in reducing thromboembolic stroke as dose-adjusted warfarin in phase 3 randomized trials and less likely to cause hemorrhagic stroke. Pharmacokinetic and/or pharmacodynamic subanalyses of the major NOAC trials in patients with atrial fibrillation have established relationships between clinical characteristics, and drug levels and/or pharmacodynamic responses with both efficacy and safety. Based on these analyses, pharmaceutical manufacturers and regulatory authorities have provided contraindications and dosing recommendations based on clinical characteristics that are associated with drug levels and/or pharmacodynamic responses, stroke reduction, and bleeding risk to optimize the risk-benefit profile of the NOACs in the real world. The current fixed-dosing strategy of NOACs has triggered discussions about the potential value of laboratory monitoring and dose adjustment in customizing drug exposure to further improve the safety and effic...Continue Reading

Citations

Apr 9, 2020·Clinical and Translational Science·Robyn KonickiJ Robert Powell
Nov 7, 2019·Journal of Thrombosis and Thrombolysis·Florian HärtigSebastian Hörber
Jul 22, 2020·Drugs·R Monroe Crawley, Rachel L Anderson
Jun 30, 2019·Chest·Parth RaliLisa Moores
Feb 25, 2021·European Journal of Preventive Cardiology·Giuseppe BorianiUNKNOWN Council of Cardio-Oncology of the European Society of Cardiology
Mar 4, 2021·TH Open : Companion Journal to Thrombosis and Haemostasis·Krishnan ShyamkumarNoel C Chan
Apr 12, 2021·International Journal of Cardiology·Ran Nissan
Dec 12, 2020·Journal of the American College of Cardiology·Vinai C BhagirathJohn Eikelboom

❮ Previous
Next ❯

Related Concepts

Related Feeds

Arrhythmia

Arrhythmias are abnormalities in heart rhythms, which can be either too fast or too slow. They can result from abnormalities of the initiation of an impulse or impulse conduction or a combination of both. Here is the latest research on arrhythmias.

Atrial Fibrillation

Atrial fibrillation is a common arrhythmia that is associated with substantial morbidity and mortality, particularly due to stroke and thromboembolism. Here is the latest research.

Atrial Filbrillation

Atrial fibrillation refers to the abnormal heart rhythm characterized by rapid and irregular beating of the atria. Here is the latest research.