title: Implementing the new oral anticoagulants into the hospital formulary.
abstract: The new oral anticoagulants may prove to be one of most significant innovations in clinical practice in the past 60 years. Apixaban and rivaroxaban are direct inhibitors of Factor Xa, while dabigatran inhibits Factor IIa. The predictable pharmacological profile of these new agents allows physicians to prescribe these drugs without the need for routine coagulation monitoring, which is the mainstay of warfarin therapy. In addition, these new agents have not been shown to have any food interactions and minimal drug-drug interactions, interactions are limited to the p-glycoprotein (p-Gp) transporter or cytochrome P450 (CYP450) system, each drug is unique in its drug interaction profile, as will be discussed below. These unique pharmacokinetics profiles may usher in for clinicians a new era of managing thromboembolic disorders. In this article, the pharmacology of these new oral anticoagulants will be reviewed along with the major clinical trials evaluating the use of these agents for thromboembolic prophylaxis in patients undergoing total hip and knee arthroplastic surgery, the treatment of venous thromboembolic disorders and stroke prevention in atrial fibrillation. Am. J. Hematol., 2012. © 2012 Wiley Periodicals, Inc.
authors.affiliation: Thomas Jefferson University Hospitals, Jefferson Medical College, Philadelphia, Pennsylvania 19107, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Palladino
authors.forename: Lynda
authors.initials: L
authors.lastname: Thomson
authors.forename: Brian
authors.initials: B
authors.lastname: Swift
authors.forename: Geno J
authors.initials: GJ
authors.lastname: Merli
mesh_terms: D020168:ATP Binding Cassette Transporter, Subfamily B, Member 1 / Q000378:metabolism; D000284:Administration, Oral; D000925:Anticoagulants / Q000009:adverse effects / Q000493:pharmacokinetics* / Q000627:therapeutic use*; D019644:Arthroplasty, Replacement, Hip; D019645:Arthroplasty, Replacement, Knee; D001281:Atrial Fibrillation / Q000097:blood / Q000150:complications / Q000188:drug therapy; D002986:Clinical Trials as Topic; D003577:Cytochrome P-450 Enzyme System / Q000378:metabolism; D004347:Drug Interactions; D065427:Factor Xa Inhibitors; D018565:Food-Drug Interactions; D005572:Formularies, Hospital as Topic; D006801:Humans; D011516:Prothrombin / Q000037:antagonists & inhibitors; D020521:Stroke / Q000097:blood / Q000517:prevention & control; D013923:Thromboembolism / Q000097:blood / Q000209:etiology / Q000517:prevention & control*
chemical_list: D020168:ATP Binding Cassette Transporter, Subfamily B, Member 1; D000925:Anticoagulants; D065427:Factor Xa Inhibitors; D011516:Prothrombin; C025337:Factor IIa; D003577:Cytochrome P-450 Enzyme System