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Transitioning to and from the novel oral anticoagulants: a management strategy for clinicians

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Abstract

Vitamin K antagonists have been the only available oral anticoagulant therapy for decades until the recent introduction of novel (new) oral anticoagulants. This breakthrough provides patients with alternative treatment choices that have predictable pharmacokinetics and do not require routine coagulation monitoring. Though more convenient from patient perspective, these drugs have distinct pharmacological properties that are particularly important to recognize when transitioning anticoagulant therapies. The following review focuses on transitioning to and from the novel oral anticoagulants, employing a practical pharmacokinetic- and pharmacodynamic-based approach.

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Abbreviations

NOAC:

Novel oral anticoagulants

VKA:

Vitamin K antagonists

VTE:

Venous thromboembolism

AF:

Atrial fibrillation

UFH:

Unfractionated heparin

LMWH:

Low molecular weight heparin

INR:

International normalized ratio

aPTT:

Activated partial thromboplastin time

P-gp:

P-glycoprotein

GFR:

Glomerular filtration rate

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  1. Division of Cardiovascular Health and Disease, University of Cincinnati College of Medicine, University of Cincinnati, 231 Albert Sabin Way, Room 3461 MSB, PO Box 670542, Cincinnati, OH, 45267-0542, USA

    Elsayed Abo-Salem & Richard Becker

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Correspondence to Elsayed Abo-Salem.

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Abo-Salem, E., Becker, R. Transitioning to and from the novel oral anticoagulants: a management strategy for clinicians. J Thromb Thrombolysis 37, 372–379 (2014). https://doi.org/10.1007/s11239-014-1060-y

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