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Review
. 2023 Sep 13;12(18):5955.
doi: 10.3390/jcm12185955.

Management of Patients Treated with Direct Oral Anticoagulants in Clinical Practice and Challenging Scenarios

Fabiana Lucà  1 , Fabrizio Oliva  2 , Maurizio Giuseppe Abrignani  3 , Stefania Angela Di Fusco  4 , Iris Parrini  5 , Maria Laura Canale  6 , Simona Giubilato  7 , Stefano Cornara  8 , Martina Nesti  9 , Carmelo Massimiliano Rao  1 , Andrea Pozzi  10 , Giulio Binaghi  11 , Alessandro Maloberti  2 , Roberto Ceravolo  12 , Irma Bisceglia  13 , Roberta Rossini  14 , Pier Luigi Temporelli  15 , Antonio Francesco Amico  16 , Raimondo Calvanese  17 , Sandro Gelsomino  18 , Carmine Riccio  19 , Massimo Grimaldi  20 , Furio Colivicchi  4 , Michele Massimo Gulizia  21
Affiliations
Review

Management of Patients Treated with Direct Oral Anticoagulants in Clinical Practice and Challenging Scenarios

Fabiana Lucà et al. J Clin Med. .

Abstract

It is well established that direct oral anticoagulants (DOACs) are the cornerstone of anticoagulant strategy in atrial fibrillation (AF) and venous thromboembolism (VTE) and should be preferred over vitamin K antagonists (VKAs) since they are superior or non-inferior to VKAs in reducing thromboembolic risk and are associated with a lower risk of intracranial hemorrhage (IH). In addition, many factors, such as fewer pharmacokinetic interactions and less need for monitoring, contribute to the favor of this therapeutic strategy. Although DOACs represent a more suitable option, several issues should be considered in clinical practice, including drug-drug interactions (DDIs), switching to other antithrombotic therapies, preprocedural and postprocedural periods, and the use in patients with chronic renal and liver failure and in those with cancer. Furthermore, adherence to DOACs appears to remain suboptimal. This narrative review aims to provide a practical guide for DOAC prescription and address challenging scenarios.

Keywords: Catheter Ablation of Atrial Fibrillation (CAAF); Over-Weight Patients; Under-Weight Patients; adherence; atrial fibrillation (AF); cancer; chronic kidney disease (CKD); chronic liver disease (CLD); direct oral anticoagulants (DOACs); drug–drug interactions (DDIs); dual antiplatelet therapy (DAPT); elderly; frailty; implantable cardioverter-defibrillator (ICD) implantation; malignancy; non-cardiac surgery; obesity; pacemaker; triple antithrombotic therapy (TAT); vitamin K antagonists (VKAs).

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Figure 1
Figure 1
Role of hepatic function in balancing homeostasis and anti-thrombotic function.
Figure 2
Figure 2
Balance on ischemic and bleeding risk factors.
Figure 3
Figure 3
Management of anticoagulant and antiplatelet strategies in different coronary setting Abb: ACS: acute coronary syndrome; PCI: Percutaneous Coronary Intervention; CCS: chronic coronary syndrome: OAC: oral anticoagulant; P2Y12i: P2Y12 inhibitor; ASA: aspirin; mo.: month.
See this image and copyright information in PMC

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