Novel oral anticoagulants: pharmacology, coagulation measures, and considerations for reversal.
Novel oral anticoagulants (NOAC) provide an effective and, in some cases, superior alternative to traditional, oral vitamin K antagonists such as warfarin. These drugs differ in their pharmacokinetic and pharmacodynamics profiles, which is important for selecting the right drug for the right patient. A concern among clinicians is a virtual absence of guidance from clinical trials for reversing the anticoagulant effects of these drugs in clinical settings such as life-threatening bleeding or a need for emergent procedures that carry bleeding risk. In this review, we discuss NOAC, the role of coagulation assays to assess their systemic anticoagulants effects, and the available data supporting strategies designed to reverse or attenuate these effects.
Division of Cardiology, Department of Medicine, Duke Clinical Research Institute, Duke University School of Medicine, DUMC 3850, Durham, NC, 27710, USA, larry.jackson@dm.duke.edu.
Larry R
LR
Jackson
Richard C
RC
Becker
D000284:Administration, Oral; D000925:Anticoagulants / Q000009:adverse effects / Q000493:pharmacokinetics* / Q000627:therapeutic use*; D001777:Blood Coagulation / Q000187:drug effects*; D002986:Clinical Trials as Topic; D006470:Hemorrhage / Q000139:chemically induced / Q000517:prevention & control; D006801:Humans; D008991:Monitoring, Physiologic / Q000379:methods*
D000925:Anticoagulants