TY - JOUR
T1 - Direct-Acting Oral Anticoagulants in Critically Ill Patients
AU - Rali, Parth
AU - Gangemi, Andrew
AU - Moores, Aimee
AU - Mohrien, Kerry
AU - Moores, Lisa
N1 - Publisher Copyright:
© 2019 American College of Chest Physicians
PY - 2019/9
Y1 - 2019/9
N2 - The direct-acting oral anticoagulants (DOACs) have been increasingly used over vitamin K antagonists in recent years because they do not require monitoring and have an immediate anticoagulation effect. In general, DOACs have exhibited a better safety profile and noninferiority for prophylaxis and treatment of venous thromboembolism (VTE) and stroke prevention in patients with atrial fibrillation compared with vitamin K antagonists in the non-ICU population; whether this finding holds true in patients who are critically ill remains unknown. The current review addresses the role of DOACs in special ICU populations, use of these agents for VTE prophylaxis, perioperative management of DOACs, drug monitoring, and potential drug interactions of DOACs in critically ill patients. Adverse events and available reversal agents for DOACs are also discussed.
AB - The direct-acting oral anticoagulants (DOACs) have been increasingly used over vitamin K antagonists in recent years because they do not require monitoring and have an immediate anticoagulation effect. In general, DOACs have exhibited a better safety profile and noninferiority for prophylaxis and treatment of venous thromboembolism (VTE) and stroke prevention in patients with atrial fibrillation compared with vitamin K antagonists in the non-ICU population; whether this finding holds true in patients who are critically ill remains unknown. The current review addresses the role of DOACs in special ICU populations, use of these agents for VTE prophylaxis, perioperative management of DOACs, drug monitoring, and potential drug interactions of DOACs in critically ill patients. Adverse events and available reversal agents for DOACs are also discussed.
KW - antithrombotic therapy
KW - critical care
KW - drugs
UR - http://www.scopus.com/inward/record.url?scp=85070739795&partnerID=8YFLogxK
U2 - 10.1016/j.chest.2019.05.025
DO - 10.1016/j.chest.2019.05.025
M3 - Review article
C2 - 31251908
AN - SCOPUS:85070739795
SN - 0012-3692
VL - 156
SP - 604
EP - 618
JO - Chest
JF - Chest
IS - 3
ER -