期刊
JOURNAL OF CLINICAL MEDICINE
卷 12, 期 18, 页码 -出版社
MDPI
DOI: 10.3390/jcm12185955
关键词
direct oral anticoagulants (DOACs); atrial fibrillation (AF); vitamin K antagonists (VKAs); adherence; cancer; malignancy; chronic kidney disease (CKD); chronic liver disease (CLD); drug-drug interactions (DDIs); triple antithrombotic therapy (TAT); dual antiplatelet therapy (DAPT); pacemaker; implantable cardioverter-defibrillator (ICD) implantation; Catheter Ablation of Atrial Fibrillation (CAAF); non-cardiac surgery; elderly; frailty; obesity; Under-Weight Patients; Over-Weight Patients
DOACs are widely used in anticoagulant therapy for atrial fibrillation and venous thromboembolism, with advantages over other treatments. However, several considerations, including drug interactions and patient-specific factors, need to be taken into account in clinical practice.
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.
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