Title:Novel Oral Anticoagulants for Venous Thromboembolism with Special Emphasis on Risk of Hemorrhagic Complications and Reversal Agents
Volume: 11
Issue: 1
Author(s): Zaheer Ahmed*, Seemeen Hassan and Gary A. Salzman
Affiliation:
- University of Missouri, Kansas City School of Medicine, 2301 Holmes Street, Kansas City, MO, 64108, USA.,United States
Keywords:
Novel anticoagulants, dabigatran, rivaroxaban, apixaban, bleeding, hemorrhagic complications,
warfarin, deep venous thrombosis (DVT), pulmonary embolism (PE), venous thromboembolism (VTE),
vitamin K antagonist (VKA), idarucizumab, andexanet alfa.
Abstract: Warfarin was the only oral anticoagulant available for the treatment of venous
thromboembolism for about half a century until the recent approval of novel oral agents
dabigatran, rivoraxaban and apixaban. This presents new classes of medications less
cumbersome to use. They do not require frequent laboratory monitoring or have nurmerous
drug interactions. On the other hand it also poses a challenge to the physicians deciding
which agent to use in specific patient populations, how to predict the bleeding risk
compared to warfarin and between the different novel agents and how to manage bleeding
with relatively recent discovery of few potential antidotes. This review summarizes the major trials that led to
the approval of these agents and their exclusion criteria helping physicians understand which patient types
might not benefit from these agents. It provides clinical pearls invaluable in everyday practice such as
transitioning between traditional and novel anticoagulants, dose adjustments for high risk populations, drug
interactions and cost analysis. Futhermore, the review provides direct comparisons with warfarin and indirect
comparisons among the novel agents in terms of efficacy and bleeding risk narrating the numbers of patients
with intracranial, gastrointestinal and fatal hemorrhages in each of the major trials. We hope that this review
will help the physicians inform their patients about the benefits and risks of these agents and enable them to
make an informed selection of the most appropriate anticoagulant.
