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Direct Oral Anticoagulant Use in Special Populations: Elderly, Obesity, and Renal Failure

  • Invasive Electrophysiology and Pacing (E. Kevin Heist, Section Editor)
  • Published:
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Abstract

Purpose of Review

The purpose of this review is to examine the safety and effectiveness of direct oral anticoagulants and provide recommendations for the treatment of venous thromboembolism and atrial fibrillation in obese patients, elderly patients, and patients with chronic kidney disease.

Recent Findings

Multiple retrospective cohort studies have shown no difference in bleeding, stroke, or venous thromboembolism outcomes between DOACs and warfarin in patients who are obese, elderly, or those with chronic kidney disease or on dialysis. Some studies have shown that DOACs have a lower bleeding risk than warfarin in these populations.

Summary

DOACs may be a safe and effective alternative to warfarin for the prevention of stroke in atrial fibrillation patients who are obese, elderly, or those with chronic kidney disease or on dialysis. Apixaban may improve clinical outcomes by lowering the risk of bleeding versus warfarin. DOACs may also be an effective and safe alternative to warfarin for the treatment of venous thromboembolism in obese patients; however, additional studies are needed to assess their use in elderly patients and those with CKD.

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Authors and Affiliations

  1. Implementation Science and Pharmacoanalytics Fellow, Department of Pharmacy and Therapeutics, University of Pittsburgh School of Pharmacy, Pittsburgh, PA, USA

    Evan M. White

  2. Department of Pharmacy and Therapeutics, University of Pittsburgh School of Pharmacy, Pittsburgh, PA, USA

    James C. Coons

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James C. Coons reports other funding from Pfizer, Inc. and Bristol-Myers Squibb unrelated to the submitted work. Evan White has nothing to disclose.

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White, E.M., Coons, J.C. Direct Oral Anticoagulant Use in Special Populations: Elderly, Obesity, and Renal Failure. Curr Cardiol Rep 23, 27 (2021). https://doi.org/10.1007/s11886-021-01456-9

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