Key result
NOACs offer effective thromboembolism prevention over warfarin but introduce distinct clinical management challenges.
Why the study?
New oral anticoagulants dabigatran and rivaroxaban have been recently approved, but their clinical use and management present unique challenges compared to warfarin.
New oral anticoagulants offer alternatives to warfarin for VTE and stroke prevention but require careful perioperative and bleeding management due to the lack of specific reversal agents.
May expand anticoagulation choices in trauma; leaves open standardized reversal and perioperative protocols.
During the last 2 years, two new oral anticoagulants, dabigatran and rivaroxaban, have been approved in the United States. Phase II and Phase III clinical trials of dabigatran, rivaroxaban, and apixaban are summarized. Approach to perioperative management depends on the half-life of the medication, risk of surgical bleeding, and the patient's renal function. No reversal agent is available for any of the new oral anticoagulants. Management of bleeding patients is based on local measures and consideration of antifibrinolytic therapy and activated factor VII or prothrombin complex concentrate infusion based on healthy volunteer and animal studies. The new oral anticoagulants provide additional options to prevent venous thromboembolism in patients after orthopedic surgery or stroke in patients with atrial fibrillation but present unique challenges compared to warfarin.
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Kreuziger et al. (2012) conducted a review in Venous thromboembolism, stroke, atrial fibrillation. New oral anticoagulants (dabigatran, rivaroxaban, apixaban) vs. Warfarin was evaluated. New oral anticoagulants (dabigatran, rivaroxaban, and apixaban) provide additional options to prevent venous thromboembolism and stroke but present unique management challenges compared to warfarin.
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