Italian intersociety consensus on DOAC use in internal medicine
- 13 February 2017
- journal article
- research article
- Published by Springer Science and Business Media LLC in Internal and Emergency Medicine
- Vol. 12 (3), 387-406
- https://doi.org/10.1007/s11739-017-1628-6
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.Keywords
This publication has 72 references indexed in Scilit:
- Andexanet Alfa for Acute Major Bleeding Associated with Factor Xa InhibitorsNew England Journal of Medicine, 2016
- When and how to use antidotes for the reversal of direct oral anticoagulants: guidance from the SSC of the ISTHJournal of Thrombosis and Haemostasis, 2015
- New oral anticoagulants: a practical guide on prescription, laboratory testing and peri‐procedural/bleeding managementInternal Medicine Journal, 2014
- Combined Administration of Antibiotics and Direct Oral Anticoagulants: A Renewed Indication for Laboratory Monitoring?Seminars in Thrombosis and Hemostasis, 2014
- New Oral Anticoagulants and the Cancer PatientThe Oncologist, 2013
- Safety and efficacy of interrupted dabigatran for peri-procedural anticoagulation in catheter ablation of atrial fibrillation: a systematic review and meta-analysisEP Europace, 2013
- Decision making for oral anticoagulants in atrial fibrillation: The ATA-AF studyEuropean Journal of Internal Medicine, 2013
- The laboratory and the direct oral anticoagulantsBlood, 2013
- The acute management of haemorrhage, surgery and overdose in patients receiving dabigatranEmergency Medicine Journal, 2013
- ACC/AHA/ESC guidelines for the management of patients with atrial fibrillation: executive summaryJournal of the American College of Cardiology, 2001