Direct Oral Anticoagulants

摘要: Direct oral anticoagulants (DOACs) are approved for multiple thromboembolic disorders and provide advantages over existing agents. As with all anticoagulants, management protocols the eventuality of bleeding important. Randomized phase III studies generally show that DOACs have a similar risk clinically relevant compared standard reductions in major some cases. This may be particularly important patients atrial fibrillation, whom rate intracranial hemorrhage was approximately halved warfarin. Conversely, gastrointestinal increased. Specific patient characteristics, such as renal impairment, comedications, particular aspects each drug, including proportion eliminated by kidneys, must taken into account when assessing bleeding. Although routine coagulation monitoring is not required, it useful under circumstances. Of traditional clotting assays, sensitive calibrated prothrombin time detecting presence or absence factor Xa inhibitor concentrations (rivaroxaban apixaban), but specific anti-factor assays can measure drug levels quantitatively. For dabigatran, results an activated partial thromboplastin test exclude pharmacodynamic effect, dilute thrombin assay used quantification levels. In event mild moderate bleeding, normal hemostatic support measures recommended. life-threatening use nonspecific prohemostatic agents considered, although clinical evidence scarce. antidotes development.