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

被引：29

作者：

Luca, Fabiana ^{[1
]}

Oliva, Fabrizio ^{[2
]}

Abrignani, Maurizio Giuseppe ^{[3
]}

Di Fusco, Stefania Angela ^{[4
]}

Parrini, Iris ^{[5
]}

Canale, Maria Laura ^{[6
]}

Giubilato, Simona ^{[7
]}

Cornara, Stefano ^{[8
]}

Nesti, Martina ^{[9
]}

Rao, Carmelo Massimiliano ^{[1
]}

Pozzi, Andrea ^{[10
]}

Binaghi, Giulio ^{[11
]}

Maloberti, Alessandro ^{[2
]}

Ceravolo, Roberto ^{[12
]}

Bisceglia, Irma ^{[13
]}

Rossini, Roberta ^{[14
]}

Temporelli, Pier Luigi ^{[15
]}

Amico, Antonio Francesco ^{[16
]}

Calvanese, Raimondo ^{[17
]}

Gelsomino, Sandro ^{[18
]}

Riccio, Carmine ^{[19
]}

Grimaldi, Massimo ^{[20
]}

Colivicchi, Furio ^{[4
]}

Gulizia, Michele Massimo ^{[21
]}

机构：

[1] AO Bianchi Melacrino Morelli, Grande Osped Metropolitano, Cardiol Dept, I-89129 Reggio Di Calabria, Italy

[2] Osped Niguarda Ca Granda, Cardiol Dept, De Gasperis Cardio Ctr, I-20162 Milan, Italy

[3] P Borsellino Hosp, Operat Unit Cardiol, I-91025 Marsala, Italy

[4] ASL Roma 1, San Filippo Neri Hosp, Clin & Rehabil Cardiol Dept, I-00135 Rome, Italy

[5] Osped Mauriziano Umberto 1, Cardiol Dept, I-10128 Turin, Italy

[6] Nuovo Osped Versilia Lido Camaiore Lucca, Cardiol Dept, I-55049 Camaiore, Italy

[7] Cannizzaro Hosp, Cardiol Dept, I-95126 Catania, Italy

[8] Osped San Paolo, Azienda Sanit Locale 2, Div Cardiol, Arrhytmia Unit, I-17100 Savona, Italy

[9] Fdn Toscana G Monasterio, I-56124 Pisa, Italy

[10] Valduce Hosp, Cardiol Div, I-22100 Como, Italy

[11] Azienda Osped Brotzu, Dept Cardiol, I-09047 Cagliari, Italy

[12] Giovanni Paolo II Hosp, Cardiol Unit, I-88046 Lamezia, Italy

[13] Azienda Osped San Camillo Forlanini, Dept Cardiothorac Vasc, Integrated Cardiol Serv, I-00152 Rome, Italy

[14] Osped Santa Croce & Carle, Cardiol Unit, I-12100 Cuneo, Italy

[15] IRCCS, Div Cardiac Rehabil, Ist Clin Sci Maugeri, I-28010 Gattico Veruno, Italy

[16] Cardiovasc Prevent & Ortokinesis Clin Lecce, I-73043 Lecce, Italy

[17] Osped Mare, Cardiol Unit, I-80147 Naples, Italy

[18] Maastricht Univ, Cardiovasc Res Inst, NL-6211 LK Maastricht, Netherlands

[19] Sant Anna & San Sebastiano Hosp, Cardiovasc Dept, I-81100 Caserta, Italy

[20] Gen Reg Hosp F Miulli, Dept Cardiol, I-70021 Bari, Italy

[21] Garibaldi Nesima Hosp, Cardiol Dept, I-95122 Catania, Italy

来源：

JOURNAL OF CLINICAL MEDICINE | 2023年 / 12卷 / 18期

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; ATRIAL-FIBRILLATION PATIENTS; VITAMIN-K ANTAGONISTS; PERCUTANEOUS CORONARY INTERVENTION; CHRONIC KIDNEY-DISEASE; QUALITY-OF-LIFE; REAL-WORLD ADHERENCE; ANTITHROMBOTIC THERAPY; MEDICATION ADHERENCE; RANDOMIZED EVALUATION; CATHETER ABLATION;

D O I：

10.3390/jcm12185955

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

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.

引用

页数：36

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