Key result
Non-vitamin K oral anticoagulants provide effective alternatives to vitamin K antagonists without requiring routine monitoring, though specific strategies are needed for bleeding and perioperative care.
This review provides practical guidance on the clinical use, laboratory monitoring, bleeding management, and perioperative handling of non-vitamin K oral anticoagulants.
May guide NOAC selection and management; leaves open prospective validation of bleeding and perioperative protocols.
Oral direct inhibitors of thrombin and activated factor Xa are approved as new anticoagulant drugs. In contrast to vitamin K antagonists (VKA) and heparins, the new agents have single targets in the coagulation cascade and more predictable pharmacokinetics, but they lack validated and available antidotes. Unlike VKA, they do not require routine monitoring of coagulation. However, the measurement of their pharmacologic effects might be of value in selected patients. They interfere with the routine coagulation tests, which should be interpreted with caution. Specific tests exist and can be used in case of emergencies. Adequate supportive care and temporary removal of all antithrombotic agents constitute the basis for management of serious bleeding complications. The administration of coagulation factors, such as fresh frozen plasma, prothrombin complex concentrates or recombinant activated FVII, can benefit in life-threatening bleeding or emergency surgery. Specific antidotes for non-vitamin K oral anticoagulants are in clinical development. This review aims at answering in a brief and simplified manner some clinical questions.
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Ciuruś et al. (2015) conducted a review in Patients requiring anticoagulation (e.g., atrial fibrillation, venous thromboembolism). Non-vitamin K oral anticoagulants (dabigatran, rivaroxaban, apixaban, edoxaban) vs. Vitamin K antagonists was evaluated. Non-vitamin K oral anticoagulants provide effective alternatives to vitamin K antagonists without requiring routine monitoring, though specific strategies are needed for bleeding and perioperative care.
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