Yorkgitis BK, Zhang J, Rappold JF. Non–Vitamin K Antagonist Oral Anticoagulants: The Clinician’s New Challenge. J Am Osteopath Assoc 2015;115(10):612–621. doi: 10.7556/jaoa.2015.122.
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Millions of US patients are prescribed oral anticoagulants. Traditionally, oral anticoagulation was achieved with vitamin K antagonists (VKAs). In recent years, non–VKA oral anticoagulants (NOACs) have emerged that provide an effective and convenient alternative to VKAs. These agents possess very different pharmacologic properties from what the medical community has grown accustom to with the VKAs. Thus, a new knowledge base is required for NOACs. One particular challenge with the NOACs is the lack of specific reversal agent, resulting in difficulties correcting the coagulopathy induced by these drugs when needed. A review of the current literature is presented to assist clinicians in gaining knowledge of the NOACs to care for patients.
Editor's Note:Corrections to this article were published in the December 2015 issue of The Journal of the American Osteopathic Association (2015;115(12):701). The corrections have been incorporated in this online version of the article. An explanation of these changes is available at http://jaoa.org/article.aspx?articleid=2474287.
Abbreviations: ACT, activated clotting time; aPTT, activated partial thromboplastin time; ECT, ecarin clotting time; NA, not available; PT, prothrombin time; Tmax, time to maximum concentration; TT, thrombin time.
a Risk factors include age older than 80 years, weight less than 60 kg, serum creatinine level above 1.5 mg/dL, and end-stage renal disease with hemodialysis.
b For the remainder of treatment
Abbreviations: CrCl, creatinine clearance; NA, not applicable; NVAF, nonvalvular atrial fibrillation; VTE, venous thromboembolism.
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