Key result
Due to a lack of clinical trials in ICU settings, current evidence suggests switching direct oral anticoagulants to parenteral anticoagulants for critically ill patients admitted to the ICU.
Why the study?
Despite increasing use of direct oral anticoagulants, there are few studies about their use in critically ill patients.
Due to limited evidence and changing pathophysiology, DOAC regimens in critically ill ICU patients require a high degree of individualization.
Requires individualized DOAC management in ICU; leaves open optimal strategy pending dedicated trials.
During the last decade, utilization of direct oral anticoagulants (DOACs) has increased due to their pharmacokinetic profile and the fact that they are non-inferior to warfarin in the prevention of stroke in patients with atrial fibrillation, as well as for the treatment of venous thromboembolism. However, there are few studies about their use in critically ill patients. This article aims to review available evidence on the use of DOACs in the indicated conditions and anticoagulant management of medical or surgical patients receiving DOAC before intensive care unit (ICU) admission. The rapidly changing pathophysiology and heterogeneous nature of critically ill patients combined with limited evidence often leads to a high degree of individualization of DOAC regimens in ICU patients. This article is the second part of the narrative review series on the use of DOACs in ICU patients, focusing on current "Clinical evidence". "Applied pharma-cology" has been described in the first part.
No takes yet. Share an insight, caveat, or question.
Wahab et al. (2021) conducted a review in Critically ill patients requiring ICU admission. Direct oral anticoagulants (DOACs) vs. Parenteral anticoagulants or Vitamin K antagonists was evaluated. Due to a lack of clinical trials in ICU settings, current evidence suggests switching direct oral anticoagulants to parenteral anticoagulants for critically ill patients admitted to the ICU.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: