Non-vitamin K antagonist oral anticoagulants in patients with an increased risk of bleeding

Wien Klin Wochenschr. 2018 Dec;130(23-24):722-734. doi: 10.1007/s00508-018-1381-5. Epub 2018 Aug 20.

Abstract

The 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.

Keywords: Consensus; DOACs; Dabigatran; Factor Xa inhibitors; NOACs.

MeSH terms

  • Administration, Oral
  • Aged, 80 and over
  • Anticoagulants / therapeutic use*
  • Atrial Fibrillation / drug therapy*
  • Dabigatran
  • Hemorrhage
  • Humans
  • Rivaroxaban
  • Stroke*

Substances

  • Anticoagulants
  • Rivaroxaban
  • Dabigatran