With the increasing use of the new oral anticoagulants, Stago has called for greater awareness of the impact of drug concentration on outcomes, as Laurence Loï explains.
The recent arrival of new oral anticoagulants (NOAC), also called target-specific oral anticoagulants (TSOA) or oral direct inhibitors (ODIs), such as rivaroxaban, apixaban , dabigatran, is being heralded as a major innovation, with studies showing them to be a safe, stable alternative to warfarin. The key benefit is that their pharmacokinetics are completely different to those of traditional oral anticoagulants, with routine monitoring no longer required.
Limitations of warfarin and the need for new agents
Since warfarin was first approved for clinical use in 1954, it has been the main oral anticoagulant used in the UK to stop blood from clotting in both acute antithrombotic treatment and to prevent venous thromboembolism and stroke in non-valvular atrial fibrillation. Warfarin works by inhibiting the enzyme vitamin K epoxide reductase, and routine coagulation monitoring has become the mainstay of patient therapy.
External factors such as foods rich in vitamin K and certain drugs can drastically reduce warfarin’s effectiveness. Conversely, if a medication is taken with an agent like warfarin then metabolism of that drug may be inhibited, leading to higher levels and a harmful or adverse effect on the patient.
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