Cardiology Letters 2013, 22(3):219-227

Measurement of the anticoagulant activity and reversal of anticoagulant effect of the novel oral anticoagulants - what are the options?

Remková A

Centrum hemostázy a trombózy, HemoMedika Bratislava, s.r.o., v Bratislave, Slovenská republika

The novel oral anticoagulant drugs (NOAC) represent a major advance for patients with atrial fibrillation. They offer the potential to substantially reduce morbidity and mortality due to cardioembolic stroke. These drugs, which currently include the direct thrombin inhibitor dabigatran and the direct Factor Xa inhibitor rivaroxaban, offer a number of advantages for patients, with no need for laboratory monitoring. However, safe prescription of the NOAC requires an adequate knowledge of drug pharmacology, measurement of renal function, the knowledge of the effect of these drugs on commonly performed coagulation tests, the availability of accurate laboratory tests to measure the anticoagulant effect of the NOAC in specific clinical circumstances, and the knowledge of reversal strategies to be applied in the emergency setting (in patients with bleeding complications or requiring urgent invasive procedures). The concomitant use of dabigatran or rivaroxaban and aspirin or other antiplatelet agents is associated with an increase in bleeding risk similar to that observed with warfarin. Their co-administration must be carefully evaluated also taking into account the individual risk profile.

Keywords: dabigatran; rivaroxaban; laboratory monitoring; management of bleeding; reversal strategies

Published: March 1, 2013  Show citation