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Perspectives

Practical issues with using novel oral anticoagulants

Jennifer Curnow

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Abstract

Appropriate patient selection is key to accessing the benefits of the novel oral anticoagulants without increasing the risks. Understanding how managing patients who are taking these novel anticoagulants differs from managing those taking warfarin is crucial to achieving optimal anticoagulation.

Key Points

  • The pharmacokinetic characteristics of the novel oral anticoagulants (NOACs) and warfarin differ significantly and this has important implications for patient management.
  • Current indications for NOACs in Australia are limited to patients with nonvalvular atrial fibrillation and at least one additional risk factor for stroke and primary prophylaxis of venous thromboembolism following elective hip or knee replacement surgery. Rivaroxaban is the only NOAC currently approved for the treatment and secondary prevention of venous thromboembolism.
  • Patient selection should take into account renal and liver function, the few known drug interactions and the clinical characteristics of patients who were excluded from clinical trials.
  • Routine laboratory monitoring in patients taking NOACs is not required.
  • NOACs have a more rapid onset and offset of action than warfarin, which means perioperative management is simplified, eliminating the need for bridging anticoagulation.
  • Antidotes to NOACs are in development but are not currently available for clinical use.

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