Direct acting oral anticoagulants (DOACs) in critically ill

Chest · Sep 2019

Review

Direct acting oral anticoagulants (DOACs) in critically ill patients.

The direct-acting oral anticoagulants (DOACs) have been increasingly used over vitamin K antagonists in recent years because they do not require monitoring and have an immediate anticoagulation effect. In general, DOACs have exhibited a better safety profile and noninferiority for prophylaxis and treatment of venous thromboembolism (VTE) and stroke prevention in patients with atrial fibrillation compared with vitamin K antagonists in the non-ICU population; whether this finding holds true in patients who are critically ill remains unknown. The current review addresses the role of DOACs in special ICU populations, use of these agents for VTE prophylaxis, perioperative management of DOACs, drug monitoring, and potential drug interactions of DOACs in critically ill patients. Adverse events and available reversal agents for DOACs are also discussed.

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- Parth Rali, Andrew Gangemi, Aimee Moores, Kerry Mohrien, and Lisa Moores.
- Division of Thoracic Medicine and Surgery, Temple University Hospital, Philadelphia, PA.
- Chest. 2019 Sep 1; 156 (3): 604-618.
AbstractThe direct-acting oral anticoagulants (DOACs) have been increasingly used over vitamin K antagonists in recent years because they do not require monitoring and have an immediate anticoagulation effect. In general, DOACs have exhibited a better safety profile and noninferiority for prophylaxis and treatment of venous thromboembolism (VTE) and stroke prevention in patients with atrial fibrillation compared with vitamin K antagonists in the non-ICU population; whether this finding holds true in patients who are critically ill remains unknown. The current review addresses the role of DOACs in special ICU populations, use of these agents for VTE prophylaxis, perioperative management of DOACs, drug monitoring, and potential drug interactions of DOACs in critically ill patients. Adverse events and available reversal agents for DOACs are also discussed.Copyright © 2019 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

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Direct acting oral anticoagulants (DOACs) in critically ill patients.

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Direct acting oral anticoagulants (DOACs) in critically ill patients.

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