title: Target-specific Oral Anticoagulants in the Emergency Department.
abstract: BACKGROUND
  Emergency physicians make treatment decisions in patients who present to the emergency department (ED) with acute venous thromboembolism (VTE). They also encounter patients on target-specific oral anticoagulants (TSOACs) who require urgent intervention. New approvals and increasing prescriptions for TSOACs (e.g., apixaban, dabigatran, edoxaban, and rivaroxaban) for the management of several thromboembolic disorders warrant an evaluation of the impact of these agents in the ED setting.
  
  
  OBJECTIVE
  This review discusses the use of TSOACs in the ED for the treatment of acute VTE, and highlights strategies for the management of patients on TSOACs who present to the ED with other complications, such as bleeding complications or requiring emergency surgery.
  
  
  CONCLUSIONS
  Apixaban, dabigatran, edoxaban, and rivaroxaban have been approved for the treatment of acute VTE. We discuss the impact of this on ED management of TSOAC-naïve patients and highlight results with TSOACs in high-risk subgroups including the elderly and those with prior VTE or active cancer. This review also discusses management strategies for patients on TSOACs. For emergency physicians, strategies for the management of bleeding, approaches to patient care when emergency surgery is needed, laboratory assays for measuring plasma concentrations of TSOACs, and drug-drug interactions are of special importance.
  
  
  CONCLUSIONS
  Familiarity with TSOACs will better position emergency physicians to provide state-of-the art care to their patients with VTE and help them manage potentially complicated circumstances related to the chronic use of these drugs.
authors.affiliation: Department of Emergency Medicine, Baylor College of Medicine, Houston, Texas.
authors.forename: William Frank
authors.initials: WF
authors.lastname: Peacock
authors.affiliation: Department of Emergency Medicine and Cardiovascular Research Institute, Wayne State University, Detroit, Michigan.
authors.forename: Phillip D
authors.initials: PD
authors.lastname: Levy
authors.affiliation: Houston Fire Department, Baylor College of Medicine, Houston, Texas.
authors.forename: Michael G
authors.initials: MG
authors.lastname: Gonzalez
authors.affiliation: Emergency Department, Christchurch Hospital, Christchurch, New Zealand.
authors.forename: Martin
authors.initials: M
authors.lastname: Than
mesh_terms: D000208:Acute Disease; D000284:Administration, Oral; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects / Q000097:blood / Q000627:therapeutic use*; D001780:Blood Coagulation Tests; D000069604:Dabigatran / Q000627:therapeutic use; D004347:Drug Interactions; D016903:Drug Monitoring; D004636:Emergency Service, Hospital; D065427:Factor Xa Inhibitors / Q000008:administration & dosage / Q000009:adverse effects / Q000097:blood / Q000627:therapeutic use*; D006470:Hemorrhage / Q000139:chemically induced / Q000628:therapy; D006801:Humans; D017410:Practice Guidelines as Topic; D011655:Pulmonary Embolism / Q000188:drug therapy*; D011720:Pyrazoles / Q000627:therapeutic use; D011725:Pyridines / Q000627:therapeutic use; D011728:Pyridones / Q000627:therapeutic use; D000069552:Rivaroxaban / Q000627:therapeutic use; D013844:Thiazoles / Q000627:therapeutic use; D054556:Venous Thromboembolism / Q000188:drug therapy*
chemical_list: D000925:Anticoagulants; D065427:Factor Xa Inhibitors; D011720:Pyrazoles; D011725:Pyridines; D011728:Pyridones; D013844:Thiazoles; C522181:apixaban; D000069552:Rivaroxaban; D000069604:Dabigatran; C552171:edoxaban
keywords: anticoagulation; emergency medicine; rivaroxaban; venous thromboembolism