THE CHALLENGES OF USING DIRECT ORAL ANTICOAGULANTS IN PATIENTS WITH CHRONIC KIDNEY DISEASE
Direct oral anticoagulants (DOAC) are undeniably a vital pillar of antithrombotic therapy. Dabigatran is a direct thrombin inhibitor that acts by preventing the conversion of fibrinogen to fibrin. Apixaban, betrixaban, edoxaban and rivaroxaban are selective factor Xa inhibitors. Since the first market launch of a DOAC 15 years ago, the number of indications has greatly expanded, based on their superior efficacy and safety in many clinical scenarios compared to classical vitamin K antagonists (VKAs). The indications include prevention of stroke and systemic embolism in patients with atrial fibrillation (AF); prevention of major cardiovascular events in patients with chronic coronary artery disease or peripheral artery disease; treatment of deep vein thrombosis and pulmonary embolism; prevention of recurrent venous thromboembolism (VTE); and prevention of VTE after total knee or hip replacement, or in hospitalized acutely ill medical patients. DOACs have several advantages over VKA, such as rapid onset and offset of action, limited food and drug interactions and a wider therapeutic window. They have a stable and predictable effect that allows the administration of fixed doses and does not require monitoring of the anticoagulant effect.
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