Evolving cardiovascular uses of direct-acting oral anticoagulants: a paradigm shift on the horizon?

摘要: Direct-acting oral anticoagulants (DOACs), by virtue of pharmacological properties perceived as innovative, are changing the therapeutic scenario patients requiring short- and long-term anticoagulation. The evidence gathered so far (from pre-approval pivotal trials to real-world post-marketing observational data) consistently confirms that DOACs overall comparable vitamin-K antagonists (VKAs) in terms safety, efficacy, effectiveness unequivocally documents a clinically relevant reduced risk intracranial bleeding settings non-valvular atrial fibrillation (AF) venous thromboembolism. following issues attracting considerable clinical interest: (a) identifying specific subpopulations with AF most likely benefit from one these agents (the so-called tailored therapy), (b) expanding indications emerging diseases characterized arterial thromboembolic risk. In scenarios, risk-benefit profile DOACs, compared VKAs or heparins, is still incompletely characterized. cardiology, challenging task selecting suitable even appropriate DOAC for particular phenotype prompted experts provide suggestions based on careful review subgroups RCTs. However, past few months, variegated multicenter have been published (RE-CIRCUIT, PIONEER-AF-PCI, GEMINI-ACS-1), potential influence practice. Therefore, this aims update latest evolving uses cardiovascular area, addressing impact clinicians.