Key result
New oral anticoagulants provide equal or better clinical outcomes than warfarin with reduced monitoring needs, though no established agents are clinically available to reverse their effects.
Why the study?
How do new oral anticoagulants compare to warfarin in clinical outcomes, monitoring, and management of bleeding complications?
How do new oral anticoagulants compare to warfarin in clinical outcomes, monitoring, and management of bleeding complications?
This review highlights that while new oral anticoagulants offer comparable or superior efficacy to warfarin without routine monitoring, managing acute bleeding remains challenging due to the lack of specific reversal agents.
May favor NOACs over warfarin for reduced monitoring yet complicate bleeding management; leaves open reversal agent development.
New oral anticoagulants like the direct thrombin inhibitor, dabigatran (Pradaxa®), and factor Xa-inhibitors, rivaroxaban (Xarelto®) and apixaban (Eliquis®) are available for prophylaxis and treatment of thromboembolic disease. They are emerging alternatives to warfarin and provide equal or better clinical outcome together with reduced need for routine monitoring. Methods for measuring drug concentrations are available, although a correlation between plasma drug concentrations and the risk of bleeding has not been firmly established. Standard laboratory measures like prothrombin time and activated partial thromboplastin time are not sensitive enough to detect thrombin or factor Xa inhibition provided by new oral anticoagulants. Thus, these standard tests may only be used as a crude estimation of the actual anticoagulation status. Further challenges regarding patients receiving new oral anticoagulants who presents with major bleeding or need for emergency surgery pose a unique problem. No established agents are clinically available to reverse the anticoagulant effect, although preclinical data report prothrombin complex concentrate as more efficient than fresh frozen plasma or other prohaemostatic agents. This review summaries current knowledge on approved new oral anticoagulants and discusses clinical aspects of monitoring, with particular focus on the management of the bleeding patient.
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Fenger‐Eriksen et al. (2014) conducted a review in Thromboembolic disease. New oral anticoagulants (dabigatran, rivaroxaban, apixaban) vs. Warfarin was evaluated. New oral anticoagulants provide equal or better clinical outcomes than warfarin with reduced monitoring needs, though no established agents are clinically available to reverse their effects.
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