Skip to main content

Pharmacological Profile and Indications of Non-Vitamin K Antagonist Oral Anticoagulants: Updated Review | Chapter 06 | Modern Advances in Pharmaceutical Research Vol. 2

The non-vitamin K antagonist oral anticoagulants have been approved since 2008 for the prevention of systemic embolism and stroke in patients with non-valvular atrial fibrillation with prior stroke, transient ischemic attack, or CHA2DS2-VASc score ≥2. According to the latest guidelines, if CHA2DS2-VASc score ≥2 for all male patients or if CHA2DS2-VASc score ≥3 for all female patients, oral anticoagulants are recommended, and considering shared decision between doctor and patient. However, they are contraindicated in patients with mechanical prosthetic valve and in patients with moderate-to-severe mitral stenosis and atrial fibrillation. They have also been approved for prevention and treatment of deep vein thrombosis and pulmonary embolism. Dabigatran, a direct thrombin inhibitor, was the first to be approved, followed by the factor Xa inhibitors, rivaroxaban, apixaban, and in 2015, edoxaban. They have advantages such as the use of fixed-dose, with infrequent drug interaction, rapid onset of action and do not require monitoring of their anticoagulant action. Nonetheless, they have different half-lives, the need for dose adjustment according to renal function, weight and age of the patient. Its use in pregnant women and children or adolescents is not well established. There are also peculiarities about the risks of bleeding, effects on coagulation tests and specific antidotes. Through this review we discuss the pharmacokinetics and pharmacodynamics characteristics of direct oral anticoagulants, its indications, interactions and contraindications. Analysis of its efficacy, safety, risk-benefit ratio and costs will also be addressed.

Author(s) Details

Rose Mary Ferreira Lisboa da Silva
Department of Internal Medicine, Faculty of Medicine, Federal University of Minas Gerais, Brazil.
View Volume:


Popular posts from this blog

A Prospective Study about Safety and Efficacy of Perioperative Lidocaine Infusion | Chapter 09 | New Horizons in Medicine and Medical Research Vol. 8

 Opioids cause clinically significant side effects such as respiratory depression, immunosuppression, muscle rigidity, negative inotropism, nausea, vomiting, hyperalgesia, urine retention, postoperative ileus, and drowsiness. Perioperative opioids are a major contributor to the United States' and other countries' opioid epidemics. Non-opioid analgesics, particularly lidocaine, are becoming more common for perioperative use as a result of this. A total of 185 adult patients were randomly assigned to one of two groups: control group I (105 patients) [fentanyl group] or group ii (80 patients) [opioid-free anaesthesia group]. Lidocaine 1.5 mg/kg bolus followed by 1.5 mg/kg/h infusion intraoperatively, and 1.5-2 mg/kg/h infusion for 2-8 hours postoperatively were given to patients in both groups at anaesthetic induction. Intraoperatively, both groups received analgesic adjuvants such as diclofenac 75 mg, paracetamol 1 gm, and mgso4 30-50 mg/kg. If the mean arterial pressure (map)

A Brief Study of Middleware Technologies: Programming Applications and Management Systems | Chapter 15 | Novel Research Aspects in Mathematical and Computer Science Vol. 1

  Many platforms, services, applications, hardware, and operating systems are connected through the middleware layer. Because the middleware layer abstracts much low-level complexity and makes applications and software systems portable, it allows disparate systems to interface and function together in harmony. Middleware technologies enable software engineers to swiftly construct software systems and applications, allowing developers to focus on more important tasks. This chapter examines several types of middleware systems and discusses middleware capabilities, middleware operation, middleware's function in cloud-based systems, and the best middleware platforms to use. Middleware systems are widely utilised and can be found in practically any software system or application. Middleware programmes provide as a link between many sorts of systems and protocols. They serve as a mechanism for various systems. To successfully exchange information, it runs on a variety of operating system

Patients’ Perspective of Acute Post-operative Pain Management: A Multicentre Survey of Tertiary Hospitals in Maharashtra, India | Chapter 08 | New Horizons in Medicine and Medical Research Vol. 8

 When postoperative pain is adequately controlled, patients' satisfaction and patient-related outcomes (PROs) increase. Understanding the patients' perspective is crucial since it supports in the formulation of improvement strategies. Because wrong attitudes and assumptions might block pain alleviation, patients' attitudes and beliefs are critical. As a result, a multicenter study of patients' attitudes, beliefs, experiences, and satisfaction levels with acute postoperative pain management was done in Maharashtra's tertiary hospitals. In addition, the responses were examined to evaluate if the Acute Pain Service (APS) resulted in improved patient outcomes and satisfaction. A 13-item questionnaire adapted from previous studies was used to capture patients' experiences with postoperative pain treatment. The responses of 179 patients are included in the study. The findings revealed that 91.6 percent of patients experienced postoperative pain, with 75.5 percent