Title:Novel Oral Anticoagulants: Recommendations for Patient Evaluation, Treatment Initiation, Follow-up and Perioperative Management
Volume: 15
Issue: 2
Author(s): Stefan Baumann, Aydin Huseynov, Ibrahim El-Battrawy, Matthias Renker and Ibrahim Akin
Affiliation:
Keywords:
Apixaban, dabigatran, follow-up, oral anticoagulants, patient evaluation, perioperative management, rivaroxaban.
Abstract: New oral anticoagulants (NOACs) are becoming available as alternatives to vitamin K
antagonists (VKAs) to prevent systemic embolism in patients with non-valvular atrial fibrillation for
the prevention and treatment of venous thromboembolism and pulmonary embolism.
A comprehensive understanding of the basic concepts of hemostaseology, the underlying
pharmacology, drug interactions and management of potential complications is essential for the
selection of suitable patients to receive NOACs, for correct prescription and for optimal patient treatment. Furthermore,
the use of NOACs in a perioperative setting is crucial, as it requires knowledge of time and dose of last intake of drug,
current renal function and the planned procedure in order to assess the overall risk of bleeding. Although no antidote
exists to reverse the effects of these novel drugs, selective substitution of coagulation factors and dialysis may be
necessary. Therefore, choosing the most beneficial alternative to VKAs on an individual basis can be challenging for
physicians. In conclusion, the recent introduction of NOACs represents an opportunity for anticoagulative treatment
regimes, while the benefits, risks and limitations should be reflected carefully.
The purpose of this systematic review is to highlight features and to provide practical guidance of NOACs in comparison
with VKAs that should be considered in a multifaceted decision making process to improve efficacy and safety.
