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New orally active anticoagulants in critical care and anesthesia practice: The good, the bad and the ugly


1 Department of Internal Medicine, The Common Wealth Medical College, Scranton, PA 18510, USA
2 Department of Anaesthesiology and Intensive Care Medicine, Gian Sagar Medical College, Banur, Patiala, Punjab, India
3 Department of Internal Medicine, Wright Center, Scranton, PA, USA

Correspondence Address:
Vishal Sehgal
Commonwealth Health - Regional Hospital of Scranton, Clinical Assistant Professor of Medicine, The Commonwealth Medical College, Scranton, PA 18510
USA
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-9784.114244

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Year : 2013  |  Volume : 16  |  Issue : 3  |  Page : 193-200

 

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With the adoption of dabigatran, rivaroxaban, and apixaban into clinical practice, a new era has arrived in the practice of oral anticoagulants. Venous thromboembolism (VTE) has traditionally been underdiagnosed and under treated in Asia. With increasing longevity, the diagnosis and the need for management of atrial fibrillation (AF) and VTE is likely to increase significantly. The new orally active anticoagulants (NOACs) have reasonably filled the lacunae that clinicians traditionally faced when treating patients with vitamin K antagonist (VKA). Unlike VKA, NOACs do not need frequent monitoring. Therefore, more patients are likely to get therapeutic effects of anticoagulation and thus reduce morbidity and mortality associated with VTE and AF. However, the clinicians need to be circumspect and exercise caution in use of these medications. In particular (in geriatric population), the clinicians should look out for drug-drug interactions and underlying renal insufficiency. This would ensure therapeutic efficacy and minimize bleeding complications. Here, it is important to note that the antidote for NOACs is not available and is a major concern if emergency surgical procedure is required in their presence.






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1 Department of Internal Medicine, The Common Wealth Medical College, Scranton, PA 18510, USA
2 Department of Anaesthesiology and Intensive Care Medicine, Gian Sagar Medical College, Banur, Patiala, Punjab, India
3 Department of Internal Medicine, Wright Center, Scranton, PA, USA

Correspondence Address:
Vishal Sehgal
Commonwealth Health - Regional Hospital of Scranton, Clinical Assistant Professor of Medicine, The Commonwealth Medical College, Scranton, PA 18510
USA
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-9784.114244

Rights and Permissions

With the adoption of dabigatran, rivaroxaban, and apixaban into clinical practice, a new era has arrived in the practice of oral anticoagulants. Venous thromboembolism (VTE) has traditionally been underdiagnosed and under treated in Asia. With increasing longevity, the diagnosis and the need for management of atrial fibrillation (AF) and VTE is likely to increase significantly. The new orally active anticoagulants (NOACs) have reasonably filled the lacunae that clinicians traditionally faced when treating patients with vitamin K antagonist (VKA). Unlike VKA, NOACs do not need frequent monitoring. Therefore, more patients are likely to get therapeutic effects of anticoagulation and thus reduce morbidity and mortality associated with VTE and AF. However, the clinicians need to be circumspect and exercise caution in use of these medications. In particular (in geriatric population), the clinicians should look out for drug-drug interactions and underlying renal insufficiency. This would ensure therapeutic efficacy and minimize bleeding complications. Here, it is important to note that the antidote for NOACs is not available and is a major concern if emergency surgical procedure is required in their presence.






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