Hindley, B, Lip, GYH, McCloskey, AP and Penson, PE (2023) Pharmacokinetics and pharmacodynamics of direct oral anticoagulants. Expert Opinion on Drug Metabolism and Toxicology. ISSN 1742-5255

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Abstract

Introduction: Direct oral anticoagulants (DOACs) have overtaken vitamin K antagonists to become the most widely-used method of anticoagulation for most indications. Their stable and predictable pharmacokinetics combined with relatively simple dosing, and the absence of routine monitoring has made them an attractive proposition for healthcare providers. Despite the benefits of DOACs as a class, important differences exist between individual DOAC drugs in respect of their pharmacokinetic and pharmacodynamic profiles with implications for dosing and reversal in cases of major bleeding. Areas covered: This review summarizes the state of knowledge relating to the pharmacokinetics of dabigatran (factor IIa/thrombin inhibitor) and apixaban, edoxaban and rivaroxaban (factor Xa) inhibitors. We focus on pharmacokinetic differences between the drugs which may have clinically significant implications. Expert opinion: Patient-centered care necessitates a careful consideration of the pharmacokinetic and pharmacodynamic differences between DOACs, and how these relate to individual patient circumstances. Prescribers should be aware of the potential for pharmacokinetic drug interactions with DOACs which may influence prescribing decisions in patients with multiple comorbidities. In order to give an appropriate dose of DOAC drugs, accurate estimation of renal function using the Cockcroft-Gault formula using actual body weight is necessary. An increasing body of evidence supports the use of DOACs in patients who are obese, and this is becoming more routine in clinical practice.

Item Type:	Article
Uncontrolled Keywords:	Anticoagulants; DOAC; NOAC; Pharmacodynamics; pharmacokinetics; 1115 Pharmacology and Pharmaceutical Sciences; Pharmacology & Pharmacy
Subjects:	R Medicine > RA Public aspects of medicine R Medicine > RM Therapeutics. Pharmacology R Medicine > RS Pharmacy and materia medica
Divisions:	Nursing & Allied Health Pharmacy & Biomolecular Sciences
Publisher:	Taylor & Francis
SWORD Depositor:	A Symplectic
Date Deposited:	27 Nov 2023 11:12
Last Modified:	27 Nov 2023 11:15
DOI or ID number:	10.1080/17425255.2023.2287472
URI:	https://researchonline.ljmu.ac.uk/id/eprint/21952

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