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

Fabiana Lucà; Fabrizio Oliva; Maurizio Giuseppe Abrignani; Stefania Angela Di Fusco; Iris Parrini; Maria Laura Canale; Simona Giubilato; Stefano Cornara; Martina Nesti; Carmelo Massimiliano Rao; Andrea Pozzi; Giulio Binaghi; Alessandro Maloberti; Roberto Ceravolo; Irma Bisceglia; Roberta Rossini; Pier Luigi Temporelli; Antonio Francesco Amico; Raimondo Calvanese; Sandro Gelsomino; Carmine Riccio; Massimo Grimaldi; Furio Colivicchi; Michele Massimo Gulizia

doi:10.3390/jcm12185955

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

Fabiana Lucà^*, Fabrizio Oliva, Maurizio Giuseppe Abrignani, Stefania Angela Di Fusco, Iris Parrini, Maria Laura Canale, Simona Giubilato, Stefano Cornara, Martina Nesti, Carmelo Massimiliano Rao, Andrea Pozzi, Giulio Binaghi, Alessandro Maloberti, Roberto Ceravolo, Irma Bisceglia, Roberta Rossini, Pier Luigi Temporelli, Antonio Francesco Amico, Raimondo Calvanese, Sandro GelsominoCarmine Riccio, Massimo Grimaldi, Furio Colivicchi, Michele Massimo Gulizia

^*Corresponding author for this work

Research output: Contribution to journal › (Systematic) Review article › peer-review

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.

Original language	English
Article number	5955
Number of pages	36
Journal	Journal of Clinical Medicine
Volume	12
Issue number	18
DOIs	https://doi.org/10.3390/jcm12185955
Publication status	Published - 13 Sept 2023

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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10.3390/jcm12185955Licence: CC BY

Cite this

Lucà, F., Oliva, F., Abrignani, M. G., Di Fusco, S. A., Parrini, I., Canale, M. L., Giubilato, S., Cornara, S., Nesti, M., Rao, C. M., Pozzi, A., Binaghi, G., Maloberti, A., Ceravolo, R., Bisceglia, I., Rossini, R., Temporelli, P. L., Amico, A. F., Calvanese, R., ... Gulizia, M. M. (2023). Management of Patients Treated with Direct Oral Anticoagulants in Clinical Practice and Challenging Scenarios. Journal of Clinical Medicine, 12(18), Article 5955. https://doi.org/10.3390/jcm12185955

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title = "Management of Patients Treated with Direct Oral Anticoagulants in Clinical Practice and Challenging Scenarios",

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)",

author = "Fabiana Luc{\`a} and Fabrizio Oliva and Abrignani, {Maurizio Giuseppe} and {Di Fusco}, {Stefania Angela} and Iris Parrini and Canale, {Maria Laura} and Simona Giubilato and Stefano Cornara and Martina Nesti and Rao, {Carmelo Massimiliano} and Andrea Pozzi and Giulio Binaghi and Alessandro Maloberti and Roberto Ceravolo and Irma Bisceglia and Roberta Rossini and Temporelli, {Pier Luigi} and Amico, {Antonio Francesco} and Raimondo Calvanese and Sandro Gelsomino and Carmine Riccio and Massimo Grimaldi and Furio Colivicchi and Gulizia, {Michele Massimo}",

year = "2023",

month = sep,

day = "13",

doi = "10.3390/jcm12185955",

language = "English",

volume = "12",

journal = "Journal of Clinical Medicine",

issn = "2077-0383",

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number = "18",

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Lucà, F, Oliva, F, Abrignani, MG, Di Fusco, SA, Parrini, I, Canale, ML, Giubilato, S, Cornara, S, Nesti, M, Rao, CM, Pozzi, A, Binaghi, G, Maloberti, A, Ceravolo, R, Bisceglia, I, Rossini, R, Temporelli, PL, Amico, AF, Calvanese, R, Gelsomino, S, Riccio, C, Grimaldi, M, Colivicchi, F & Gulizia, MM 2023, 'Management of Patients Treated with Direct Oral Anticoagulants in Clinical Practice and Challenging Scenarios', Journal of Clinical Medicine, vol. 12, no. 18, 5955. https://doi.org/10.3390/jcm12185955

TY - JOUR

T1 - Management of Patients Treated with Direct Oral Anticoagulants in Clinical Practice and Challenging Scenarios

AU - Lucà, Fabiana

AU - Oliva, Fabrizio

AU - Abrignani, Maurizio Giuseppe

AU - Di Fusco, Stefania Angela

AU - Parrini, Iris

AU - Canale, Maria Laura

AU - Giubilato, Simona

AU - Cornara, Stefano

AU - Nesti, Martina

AU - Rao, Carmelo Massimiliano

AU - Pozzi, Andrea

AU - Binaghi, Giulio

AU - Maloberti, Alessandro

AU - Ceravolo, Roberto

AU - Bisceglia, Irma

AU - Rossini, Roberta

AU - Temporelli, Pier Luigi

AU - Amico, Antonio Francesco

AU - Calvanese, Raimondo

AU - Gelsomino, Sandro

AU - Riccio, Carmine

AU - Grimaldi, Massimo

AU - Colivicchi, Furio

AU - Gulizia, Michele Massimo

PY - 2023/9/13

Y1 - 2023/9/13

N2 - 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.

AB - 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.

KW - Catheter Ablation of Atrial Fibrillation (CAAF)

KW - Over-Weight Patients

KW - Under-Weight Patients

KW - adherence

KW - atrial fibrillation (AF)

KW - cancer

KW - chronic kidney disease (CKD)

KW - chronic liver disease (CLD)

KW - direct oral anticoagulants (DOACs)

KW - drug–drug interactions (DDIs)

KW - dual antiplatelet therapy (DAPT)

KW - elderly

KW - frailty

KW - implantable cardioverter-defibrillator (ICD) implantation

KW - malignancy

KW - non-cardiac surgery

KW - obesity

KW - pacemaker

KW - triple antithrombotic therapy (TAT)

KW - vitamin K antagonists (VKAs)

U2 - 10.3390/jcm12185955

DO - 10.3390/jcm12185955

M3 - (Systematic) Review article

SN - 2077-0383

VL - 12

JO - Journal of Clinical Medicine

JF - Journal of Clinical Medicine

IS - 18

M1 - 5955

ER -