Conventional and New Oral Anticoagulants in the Treatment of Chest Disease and its Complications.
Am J Respir Crit Care Med. 2013 May 14;
Authors: Gallego P, Roldan V, Lip GY
Oral anticoagulants block the coagulation cascade either by an indirect mechanism (eg. vitamin K antagonists, VKAs) or by a direct one (eg. the novel oral anticoagulants, NOACs). VKAs are widely used as treatment of venous thromboembolism (VTE) and for stroke prevention in atrial fibrillation (AF) patients. Although low molecular weight heparin remains the first-line in VTE prophylaxis, more recently the novel oral anticoagulants such as dabigatran (initial dose of 110mg within 1-4 hours after surgery, followed by the full dose of 220mg once daily), rivaroxaban (dose of 10mg once daily, with the first dose administered 6-10 hours after the surgery) and apixaban (dose of 2.5mg twice daily, starting 12-24 hours after surgery, but available only in Europe) are approved for prophylaxis in patients undergoing major orthopaedic surgery. The period on which thromboembolic risk abates remains uncertain and trials on extended therapy are still ongoing. After showing at least non-inferiority to warfarin in RE-LY, ROCKET-AF and ARISTOTLE trials, dabigatran (110 or 150mg twice daily), rivaroxaban (20 or 15mg once daily) and apixaban (5mg twice daily) respectively were approved also for stroke prevention in AF patients. Whilst awaiting long-term safety data, the choice between all these available therapies should be based on patient preferences, compliance and ease of administration, as well as on local factors affecting cost-effectiveness.
PMID: 23672179 [PubMed - as supplied by publisher]