Clinical Use of Direct Oral Anticoagulants and Reversal: Consideration for Vascular Surgeons
Abstract
:1. Introduction
2. Current Indications of DOACs
3. Pharmacology of DOACs
4. Prescription Protocols
5. Future Expansion of Indications
6. DOACs during the Perioperative Period of Vascular Surgery
7. DOACs and Locoregional Anesthesia
8. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Dabigatran | Rivaroxaban | Apixaban | Edoxaban | Betrixaban | |
---|---|---|---|---|---|
Mechanism of action | IIa inhibitor | Xa inhibitor | Xa inhibitor | Xa inhibitor | Xa inhibitor |
Prodrug | Yes | No | No | No | No |
Bioavailability after oral intake (%) | 6.5 | 70 (without food) 100 (with food) | 50 | 62 | 35 |
Tmax (h) | 0.5–2 | 2–4 | 3–4 | 0.5–2 | 3–4 |
Half-life (h) | 12–14 | 7–9 (adults), 12 (elderly subjects > 75 years) | 12 | 10 | 19–27 |
Plasma binding protein (%) | 35 | >90 | 87 | 55 | 60 |
Elimination | 80 % renal, 20% hepatobiliary | 33% renal, 66% liver | 25% renal, 75% hepatobiliary | 50% renal, 50% hepatobiliary | 15% renal, 85% hepatobiliary |
Drug to drug interaction | P-gp | P-gp, CYP3A4 | P-gp, CYP3A4 | P-gp, CYP3A4 | P-gp |
Food to drug interaction | Prolongs Tmax to 2 h (intake with food is discouraged) | Intake with food is mandatory (especially for the 15 and 20 mg doses) | No effect | No effect | Intake with food is mandatory |
Contraindication in case of hepatic impairment | Child–Pugh C | Child–Pugh B or C | Child–Pugh C | Child–Pugh C | Child–Pugh B or C |
Contraindication in case of renal insufficiency | CrCl < 30 mL/min | CrCl < 15 mL/min | CrCl < 15 mL/min | CrCl < 15 mL/min | CrCl < 15 mL/min |
Dabigatran | Rivaroxaban | Apixaban | Edoxaban | Betrixaban | |
---|---|---|---|---|---|
Prevention of DVT after hip or knee replacement | 220 mg OID, 150 mg daily if 1 | 10 mg OID | 2.5 mg BID | NA | NA |
Prevention of stroke in NVAF | 150 mg BID, 110 mg BID if 1 | 20 mg OID, 15 mg daily if 2 | 5 mg BID, 2.5 mg BID if 3 | 60 mg OID, 30 mg OID if 4 | NA |
Treatment of DVT and PE | 150 mg BID, 110 mg BID if 1 | 15 mg BID × 21 days then 20 mg OID or then 15 mg OID if 2 | 10 mg BID × 5 days then 5 mg BID | 60 mg OID, 30 mg OID if 4 | NA |
Prevention of recurrent DVT and PE | 150 mg BID, 110 mg BID if 1 | 10 mg or 20 mg OID; if 2 consider 15 mg OID instead of 20 mg | 2.5 mg BID | NA | NA |
Prevention of atherothrombotic events in symptomatic PAD | NA | 2.5 mg BID + Aspirin | NA | NA | NA |
Prevention of stroke post-PCI with concomitant NVAF | 150 mg BID, 110 mg BID if 1 + Clopidogrel or Ticagrelor | 15 mg OID, 10 mg daily if 2 + Clopidogrel | 5 mg BID, 2.5 mg BID if 3 + Clopidogrel | 60 mg OID, 30 mg OID if 4 + Clopidogrel | NA |
Prevention of DVT and PE in adults hospitalized for an acute medical illness | NA | NA | NA | NA | initial single dose of 160 mg, followed by 80 mg OID; initial single dose of 80 mg, followed by 40 mg OID if 5 |
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Houben, A.; Bonhomme, V.; Senard, M. Clinical Use of Direct Oral Anticoagulants and Reversal: Consideration for Vascular Surgeons. J. Vasc. Dis. 2023, 2, 230-235. https://doi.org/10.3390/jvd2020017
Houben A, Bonhomme V, Senard M. Clinical Use of Direct Oral Anticoagulants and Reversal: Consideration for Vascular Surgeons. Journal of Vascular Diseases. 2023; 2(2):230-235. https://doi.org/10.3390/jvd2020017
Chicago/Turabian StyleHouben, Alan, Vincent Bonhomme, and Marc Senard. 2023. "Clinical Use of Direct Oral Anticoagulants and Reversal: Consideration for Vascular Surgeons" Journal of Vascular Diseases 2, no. 2: 230-235. https://doi.org/10.3390/jvd2020017