Transitioning between therapeutic anticoagulants: a clinicians guide to switching patients to or from DOAC therapy.

IF 1.8 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS
Benilde Cosmi, Michelangelo Sartori
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引用次数: 0

Abstract

Introduction: The transition to or from direct oral anticoagulants (DOACs) is common in clinical practice.

Areas covered: A literature search was conducted on PubMed, Google Scholar, and UpToDate up to March 2024 for conditions and approaches for transitioning from one agent to the other. No randomized clinical trials were retrieved except for two studies regarding switching to DOAC in well-conducted vitamin K antagonist (VKA) therapy. A narrative review was conducted addressing the conditions for switching from one agent to the other, such as thromboembolic events and major bleeding during anticoagulation, development or worsening of kidney or liver failure, initiation of interfering drugs, adverse events such as allergic reactions, frailty, patients' preferences, and affordability. During transitions from one anticoagulant to the other, the risk of both thromboembolic and bleeding complications should be minimized. The current approaches for such transitions are derived from those employed in clinical trials evaluating DOAC and from product information.

Expert opinion: Many uncertainties remain regarding those circumstances requiring a change in anticoagulant strategies, as they lack evidence-based guidance. It can be envisaged that the problem of switching to and from DOAC will need additional studies especially addressing the conditions and the best approach to such transitions.

治疗性抗凝剂之间的转换:临床医生指导患者转用或停用 DOAC 治疗。
简介:直接口服抗凝药(DOACs)的转换在临床实践中很常见:截至 2024 年 3 月,我们在 PubMed、Google Scholar 和 UpToDate 上对从一种药物过渡到另一种药物的条件和方法进行了文献检索。除两项关于在维生素 K 拮抗剂 (VKA) 治疗中转用 DOAC 的研究外,未检索到其他随机临床试验。我们针对从一种药物转为另一种药物的条件进行了叙述性综述,如抗凝期间的血栓栓塞事件和大出血、肝肾功能衰竭的发展或恶化、干扰药物的启动、过敏反应等不良事件、体弱、患者的偏好以及经济承受能力。在从一种抗凝药过渡到另一种抗凝药的过程中,血栓栓塞和出血并发症的风险都应降到最低。目前的过渡方法来自于评估 DOAC 的临床试验和产品信息:专家意见:由于缺乏循证指导,需要改变抗凝策略的情况仍存在许多不确定性。可以预见,需要对 DOAC 的转换问题进行更多研究,尤其是针对此类转换的条件和最佳方法。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Expert Review of Cardiovascular Therapy
Expert Review of Cardiovascular Therapy CARDIAC & CARDIOVASCULAR SYSTEMS-
CiteScore
3.70
自引率
0.00%
发文量
82
期刊介绍: Expert Review of Cardiovascular Therapy (ISSN 1477-9072) provides expert reviews on the clinical applications of new medicines, therapeutic agents and diagnostics in cardiovascular disease. Coverage includes drug therapy, heart disease, vascular disorders, hypertension, cholesterol in cardiovascular disease, heart disease, stroke, heart failure and cardiovascular surgery. The Expert Review format is unique. Each review provides a complete overview of current thinking in a key area of research or clinical practice.
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