title: Italian intersociety consensus on DOAC use in internal medicine.
abstract: The direct oral anticoagulants (DOACs) are drugs used in clinical practice since 2009 for the prevention of stroke or systemic embolism in non-valvular atrial fibrillation, and for the treatment and secondary prevention of venous thromboembolism. The four DOACs, including the three factor Xa inhibitors (rivaroxaban, apixaban and edoxaban) and one direct thrombin inhibitor (dabigatran) provide oral anticoagulation therapy alternatives to Vitamin K antagonists (VKAs). Despite their clear advantages, the DOACs require on the part of the internist a thorough knowledge of their pharmacokinetic and pharmacodynamic characteristics to ensure their correct use, laboratory monitoring and the appropriate management of adverse events. This document represents a consensus paper on the use of DOACs by representatives of three Italian scientific societies: the Italian Society of Internal Medicine (SIMI), the Federation of the Associations of Hospital Managers (FADOI), and the Society for the Study of Haemostasis and Thrombosis (SISET). This document formulates expert opinion guidance for pragmatic managing, monitoring and reversing the anticoagulant effect of DOACs in both chronic and emergency settings. This practical guidance may help the internist to create adequate protocols for patients hospitalized ion internal medicine wards, where patients are often elderly subjects affected by poly-morbidities and renal insufficiency, and, thus, require particular attention to drug-drug interactions and peri-procedural protocols.
authors.affiliation: Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy. domenico.prisco@unifi.it.
authors.forename: Domenico
authors.initials: D
authors.lastname: Prisco
authors.affiliation: Department of Clinical and Experimental Medicine, Insubria University, Varese, Italy.
authors.forename: Walter
authors.initials: W
authors.lastname: Ageno
authors.affiliation: Internal and Cardiovascular Medicine-Stroke Unit, University of Perugia, Perugia, Italy.
authors.forename: Cecilia
authors.initials: C
authors.lastname: Becattini
authors.affiliation: Coagulation Service and Thrombosis Research Unit, Scientific Institute San Raffaele, Milan, Italy.
authors.forename: Armando
authors.initials: A
authors.lastname: D'Angelo
authors.affiliation: Clinica Medica, Department of Medicine and Aging Sciences, University of Chieti G.D'Annunzio, Chieti, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Davì
authors.affiliation: Institute of Internal Medicine and Geriatrics, Center for Haemorrhagic and Thrombotic Diseases, Haematology, Foundation Policlinico universitario "Agostino Gemelli", Catholic University of the Sacred Heart, Rome, Italy.
authors.forename: Raimondo
authors.initials: R
authors.lastname: De Cristofaro
authors.affiliation: Department of Clinical and Experimental Medicine, Insubria University, Varese, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Dentali
authors.affiliation: Clinica Medica, Department of Clinical Medicine and Surgery, AOU Policlinico Federico II, Naples, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Di Minno
authors.affiliation: Department of Immunohematology and Transfusion Medicine, and the Thrombosis and Hemostasis Center, Hospital Papa Giovanni XXIII, Bergamo, Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Falanga
authors.affiliation: Department of Clinical Research, FADOI, Milan, Italy.
authors.forename: Gualberto
authors.initials: G
authors.lastname: Gussoni
authors.affiliation: Internal Medicine, Santa Maria Nuova Hospital, Florence, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Masotti
authors.affiliation: Cardiovascular Diseases, University of Bologna, Bologna, Italy.
authors.forename: Gualtiero
authors.initials: G
authors.lastname: Palareti
authors.affiliation: Department of Internal Medicine and Medical Specialties, "La Sapienza" University of Rome, Rome, Italy.
authors.forename: Pasquale
authors.initials: P
authors.lastname: Pignatelli
authors.affiliation: Haemostasis and Thrombosis Unit, Haematology, Az. Osp. "SS.Antonio e Biagio e C. Arrigo", Alessandria, Italy.
authors.forename: Roberto M
authors.initials: RM
authors.lastname: Santi
authors.affiliation: Clinica Medica, Department of Medicine and Aging Sciences, University of Chieti G.D'Annunzio, Chieti, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Santilli
authors.affiliation: Internal Medicine Unit A - Ospedale Maggiore, AUSL Bologna, Bologna, Italy.
authors.forename: Mauro
authors.initials: M
authors.lastname: Silingardi
authors.affiliation: Clinica Medica, Department of Clinical Medicine and Surgery, AOU Policlinico Federico II, Naples, Italy.
authors.forename: Antonella
authors.initials: A
authors.lastname: Tufano
authors.affiliation: Department of Internal Medicine and Medical Specialties, "La Sapienza" University of Rome, Rome, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Violi
mesh_terms: D000284:Administration, Oral; D000925:Anticoagulants / Q000009:adverse effects / Q000494:pharmacology* / Q000627:therapeutic use; D000991:Antithrombins / Q000494:pharmacology / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000188:drug therapy; D002983:Clinical Competence / Q000592:standards*; D000069604:Dabigatran / Q000494:pharmacology / Q000627:therapeutic use; D064420:Drug-Related Side Effects and Adverse Reactions; D065427:Factor Xa Inhibitors / Q000627:therapeutic use; D018565:Food-Drug Interactions; D006801:Humans; D007388:Internal Medicine / Q000379:methods*; D007558:Italy; D008107:Liver Diseases / Q000209:etiology; D059035:Perioperative Period / Q000379:methods; D011720:Pyrazoles / Q000494:pharmacology / Q000627:therapeutic use; D011725:Pyridines / Q000494:pharmacology / Q000627:therapeutic use; D011728:Pyridones / Q000494:pharmacology / Q000627:therapeutic use; D000069552:Rivaroxaban / Q000494:pharmacology / Q000627:therapeutic use; D020521:Stroke / Q000188:drug therapy; D013844:Thiazoles / Q000494:pharmacology / Q000627:therapeutic use; D013997:Time Factors; D054556:Venous Thromboembolism / Q000517:prevention & control
chemical_list: D000925:Anticoagulants; D000991:Antithrombins; D065427:Factor Xa Inhibitors; D011720:Pyrazoles; D011725:Pyridines; D011728:Pyridones; D013844:Thiazoles; C522181:apixaban; D000069552:Rivaroxaban; D000069604:Dabigatran; C552171:edoxaban
keywords: Atrial fibrillation; Direct oral anticoagulant; Drug interactions; Elderly; Internist; Novel oral anticoagulant; Pulmonary embolism; Venous thromboembolism; Venous thrombosis