Direct oral anticoagulants: efficacy and safety in patient subgroups

Mavrakanas, Thomas; Samer, Caroline Flora; Fontana, Pierre; Perrier, Arnaud

doi:10.4414/smw.2015.14081

Scientific article

Review

English

Direct oral anticoagulants: efficacy and safety in patient subgroups

Contributors

Mavrakanas, Thomas; Samer, Caroline Flora

; Fontana, Pierre

; Perrier, Arnaud

Published in

Schweizerische medizinische Wochenschrift, vol. 145, w14081

Publication date

2015

Abstract

Direct oral anticoagulants have recently emerged as an attractive choice for patients requiring anticoagulation treatment. They have a rapid onset of action and can be administered at fixed doses without the need for routine anticoagulation monitoring. They may present fewer interactions than warfarin but further experience is needed to assess the clinical significance of the interactions with cytochrome CYP3A and P-gp inhibitors/inducers. A higher rate of bleeding has been observed in association with antiplatelet agents or non-steroidal anti-inflammatory drugs. Their safety profile has not been sufficiently studied in the elderly, and in patients with liver disease or severe renal impairment. Dose adjustment is necessary in patients with moderate renal impairment and a higher bleeding rate has been observed in this subgroup, although not higher than with warfarin. The clinical settings that require monitoring of coagulation assays have not yet been specified. Reversal of their anticoagulant effect may be problematic in case of severe bleeding. Therefore, despite the obvious advantages of the direct oral anticoagulants, experience is still lacking for many patient subgroups in which they should be withheld awaiting more data.

UNIGE affiliation entities

UNIGE research groups

Citation (ISO format)

MAVRAKANAS, Thomas et al. Direct oral anticoagulants: efficacy and safety in patient subgroups. In: Schweizerische medizinische Wochenschrift, 2015, vol. 145, p. w14081. doi: 10.4414/smw.2015.14081

Article (Published version)

Identifiers

PID : unige:74012
DOI : 10.4414/smw.2015.14081
PMID : 25658756

Journal ISSN

0036-7672

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Creation

06/07/2015 17:56:00

First validation

06/07/2015 17:56:00

Update

07/03/2025 14:57:26

Status update

03/02/2025 11:31:57

Last indexation

18/08/2025 11:30:48

Direct oral anticoagulants: efficacy and safety in patient subgroups

Contributors

Published in

Publication date

Abstract

UNIGE affiliation entities

UNIGE research groups

Citation (ISO format)

Main files (1)

Identifiers

Journal ISSN

Technical informations

Creation

First validation

Update

Status update

Last indexation