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Review
. 2023 Dec 29;13(1):216.
doi: 10.3390/jcm13010216.

Direct Oral Anticoagulants in Special Patient Populations

Asa Kessler  1 , Yotam Kolben  1 , Gal Puris  2 , Martin Ellis  3   4 , Mordechai Alperin  5   6 , Vered Simovich  7 , Hila Lerman Shivek  8   9 , Mordechai Muszkat  10 , Yoram Maaravi  11   12 , Yitschak Biton  1
Affiliations
Review

Direct Oral Anticoagulants in Special Patient Populations

Asa Kessler et al. J Clin Med. .

Abstract

Anticoagulants are a cornerstone of treatment in atrial fibrillation. Nowadays, direct oral anticoagulants (DOACs) are extensively used for this condition in developed countries. However, DOAC treatment may be inappropriate in certain patient populations, such as: patients with chronic kidney disease in whom DOAC concentrations may be dangerously elevated; frail elderly patients with an increased risk of falls; patients with significant drug-drug interactions (DDI) affecting either DOAC concentration or effect; patients at the extremes of body mass in whom an "abnormal" volume of distribution may result in inappropriate drug concentrations; patients with recurrent stroke reflecting an unusually high thromboembolic tendency; and, lastly, patients who experience major hemorrhage on an anticoagulant and in whom continued anticoagulation is deemed necessary. Herein we provide a fictional case-based approach to review the recommendations for the use of DOACs in these special patient populations.

Keywords: atrial fibrillation; direct oral anticoagulants; special populations.

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Conflict of interest statement

A. Kessler, Y. Kolben, M. Muszkat and Y. Biton are employees of Hadassah Medical Center, which fully owns the subsidiary Hadasit Medical Research Services and Development Ltd., which received funding from Pfizer in connection with the development of this manuscript. M. Ellis, M. Alperin, V. Simovich, H. Lerman-Shivek and Y. Maaravi were paid consultants to Pfizer in connection with the development of this manuscript. G. Puris has nothing to declare.

Figures

Figure 1
Figure 1
Algorithm for the initiation and management of DOACs in special populations. CKD, chronic kidney disease; GFR, glomerular filtration rate.
See this image and copyright information in PMC

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