Direct Oral Anticoagulants in Special Patient Populations

被引:3
作者
Kessler, Asa [1 ,2 ]
Kolben, Yotam [1 ,2 ]
Puris, Gal [3 ]
Ellis, Martin [4 ,5 ]
Alperin, Mordechai [6 ,7 ]
Simovich, Vered [8 ]
Lerman Shivek, Hila [9 ,10 ]
Muszkat, Mordechai [11 ]
Maaravi, Yoram [12 ,13 ,14 ]
Biton, Yitschak [1 ,2 ]
机构
[1] Hebrew Univ Jerusalem, Heart Inst, Hadassah Med Ctr, IL-9112002 Jerusalem, Israel
[2] Hebrew Univ Jerusalem, Fac Med, IL-9112002 Jerusalem, Israel
[3] Hebrew Univ Jerusalem, Fac Med, Israel Def Force Med Corps, Inst Res Mil Med, IL-9112102 Jerusalem, Israel
[4] Meir Med Ctr, Hematol Inst & Blood Bank, IL-4428164 Kefar Sava, Israel
[5] Tel Aviv Univ, Fac Med, IL-6997801 Tel Aviv, Israel
[6] Technion Israel Inst Technol, Ruth & Bruce Rappaport Fac Med, Dept Family Med, IL-3200003 Haifa, Israel
[7] Clalit Hlth Serv, IL-6209804 Tel Aviv, Israel
[8] Maccabi Hlth Care Serv, IL-6209804 Tel Aviv, Israel
[9] Clalit Hlth Serv, Hosp Pharm Dept, Hosp Div, IL-6209804 Tel Aviv, Israel
[10] Hebrew Univ Jerusalem, Inst Drug Res, Fac Med, Sch Pharm, IL-9112002 Jerusalem, Israel
[11] Hebrew Univ Jerusalem, Fac Med, Hadassah Med Ctr, Dept Med, IL-9112002 Jerusalem, Israel
[12] Hebrew Univ Jerusalem, Jerusalem Inst Aging Res, Fac Med, IL-9112002 Jerusalem, Israel
[13] Hadassah Med Ctr, Dept Geriatr & Rehabil, IL-9371125 Jerusalem, Israel
[14] Hadassah Med Ctr, Ctr Palliat Care, IL-9371125 Jerusalem, Israel
关键词
direct oral anticoagulants; atrial fibrillation; special populations; NONVALVULAR ATRIAL-FIBRILLATION; VITAMIN-K ANTAGONIST; CHRONIC KIDNEY-DISEASE; ELDERLY-PATIENTS; BODY-WEIGHT; INTRACEREBRAL HEMORRHAGE; BARIATRIC SURGERY; UNITED-STATES; ANTITHROMBOTIC THERAPY; THROMBOEMBOLIC EVENTS;
D O I
10.3390/jcm13010216
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
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.
引用
收藏
页数:19
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