Abstract
SummaryThe non-vitamin K antagonist oral anticoagulants (NOACs) have considerably changed clinical practice and are increasingly being used as an alternative to vitamin K antagonists (VKAs) for 3 main reasons: 1) an improved benefit-risk ratio (in particular lower rates of intracranial bleeding), 2) a more predictable effect without the need for routine monitoring, and 3) fewer food and drug interactions compared with VKAs. Currently, there are four NOACs available: the factor Xa inhibitors apixaban, edoxaban, and rivaroxaban, and the thrombin inhibitor dabigatran. This consensus paper reviews the properties and usage of NOACs in a number of high-risk patient populations, such as patients with chronic kidney disease, patients ≥80 years of age and others and provides guidance for the use of NOACs in patients at risk of bleeding.
Highlights
Since the non-vitamin K antagonist oral anticoagulants (NOACs) became available, their use increased and they continued to replace vitamin K antagonists (VKAs), in patients with atrial fibrillation (AF) and in those with venous thromboembolism (VTE)
The higher initial doses for rivaroxaban and apixaban are indicated in bold type aDabigatran and edoxaban can only be used in acute VTE after initial therapeutic anticoagulation with low molecular weight heparin (LMWH) for ≥5 days bIn patients with high bleeding risk, in patients ≥80 years and in those concomitantly taking verapamil 2 × 110 mg should be used cUse with caution dFor the first 3 weeks eAfter the first 3 weeks fReduce to 1 × 15 mg if the bleeding risk exceeds the risk of VTE gFor the first treatment week hAfter the first treatment week iThis dosage applies to patients ≤60 kg and patients taking P-glycoprotein inhibitors like cyclosporine, dronedarone, erythromycin and ketoconazole
According to the Kidney Disease—Improving Global Outcome (KDIGO) guidelines, the Chronic kidney disease (CKD)-EPI formula is recommended to evaluate renal function [8]; as already mentioned the large randomized NOAC trials applied the Cockroft-Gault formula to assess CKD and this formula should be used to estimate GFR to decide if the NOAC dosage needs to be reduced
Summary
Since the non-vitamin K antagonist oral anticoagulants (NOACs) became available, their use increased and they continued to replace vitamin K antagonists (VKAs), in patients with atrial fibrillation (AF) and in those with venous thromboembolism (VTE). There are 4 NOACs available: the factor Xa inhibitors apixaban, edoxaban and rivaroxaban and the thrombin inhibitor dabigatran. MD Department of Internal Medicine, Cardiology and Nephrology, Landesklinikum Wiener Neustadt, Wiener Neustadt, Austria. H. Domanovits Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria. G. Sengölge Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria.
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
