VOLUME

ORAL ANTICOAGULATION IN 2017

SEPTEMBER 2018 - VOL.14 | REVIEWS ARTICLE

In this paper we describe the properties and clinical use of new anticoagulants:dabigatran (a direct thrombin inhibitor) and direct anti-Xa agents (rivaroxaban, apixaban,edoxaban ). Major studies that have been performed with these agents in comparisonwith warfarin are reported. Recommendations for use in clinical practice are provided.Information on the disappearance of the anticoagulant effect after stopping drug intakeand on the administration of agents that neutralize the effect of the new anticoagulantis provided.

Keywords :

warfarin, dabigatran, anti-Xa agents, idarucizumab

Address Correspondence to author:

Frans Van, MD, PhD, FESC, FACC, FAHA Department of Cardiovascular Sciences University Hospital Leuven Herestraat-49, B-3000 Leuven, Belgium email: [email protected]

Received: November 10, 2018

Revision received: December 28, 2018

Accepted after revision: January 10, 2018

BKK Med J 2018;14(2): 81-94.

DOI: 10.31524/bkkmedj.2018.09.015

MEDIA

Figure 1: Coagulation can be activated through different pathways.

Figure 2: Comparison of mode of action of vitamin K antagonists (VKA) and Non-vitamin K antagonists Oral Anticoagulants (NOACs).

Table 1: Pharmacological properties of NOACs

Table 2: Overview of phase III studies of NOACs in the acute treatment of VTE

Figure 3: summary of results of phase III trials of NOACs in the treatment of acute VTE.

Table 3: Clinical trials of new oral anticoagulants and available alternatives in the extended treatment of secondary prevention of VTE:design and summary of results

Table 4: overview of phase III studies of NOACs in the prevention of stroke and systemic embolism in patients with non-valvular AF

Figure 4: Overview of results of phase III studies of NOACs in the prevention of stroke and systemic embolism inpatients with non-valvular AF.

Figure 5: Differences in organ-specific bleeding patterns: major bleeding in GI tract (panel A) vs intracranial hemorrhage(panel B) of NOACs compared to warfarin.

Table 5: Recommendations for interruption of NOAC therapy for elective surgical interventions: timing oflast intake of NOAC

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