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Related Concept Videos

Anticoagulant Drugs: Vitamin K Antagonists and Direct Oral Anticoagulants01:18

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Oral anticoagulants are vital tools in preventing and treating blood clotting disorders. This diverse class of medications can be categorized as vitamin K antagonists, exemplified by warfarin, and direct thrombin inhibitors (DTIs), such as dabigatran, as well as factor Xa inhibitors, including rivaroxaban.
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Hemostasis is a crucial process that prevents excessive blood loss from damaged blood vessels. It involves various mechanisms such as vasoconstriction, platelet adhesion and activation, and fibrin formation. The importance of each mechanism depends on the type of vessel injury. In contrast, thrombosis is the abnormal formation of a blood clot within the blood vessels, leading to potential complications if the clot obstructs blood flow. Thrombosis can be caused by increased coagulability of the...
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Antiplatelet drugs emerge as frontline defenders against the insidious threat of thromboembolic diseases, where abnormal clots obstruct vital blood vessels. These drugs stand as bulwarks, inhibiting platelet aggregation and clot formation, thereby mitigating the risk of life-threatening conditions like myocardial infarction, coronary artery disease, and thrombotic strokes.
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The therapeutic index of a drug is a key parameter in pharmacology that quantifies the relative safety of a drug by calculating the ratio between the dose that causes toxicity in half the population (50%) to the dose that proves to be effective for half the population (50%). It provides a spectrum of doses for a particular drug ranging from effective to potentially toxic. To illustrate, consider an anticoagulant agent like warfarin. It possesses a narrow window within its therapeutic index to...
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The target-specific oral anticoagulants: practical considerations.

David A Garcia1

  • 1University of Washington, Seattle, WA.

Hematology. American Society of Hematology. Education Program
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Target-specific oral anticoagulants (TSOACs) offer advantages but require careful management. This review addresses clinical questions regarding TSOACs, including periprocedural care and monitoring, to aid prescribing decisions.

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Area of Science:

  • Pharmacology and Therapeutics
  • Cardiovascular Medicine

Background:

  • Target-specific oral anticoagulants (TSOACs) are increasingly prescribed.
  • Clinicians face management questions not fully addressed by initial trials.
  • Familiarity with TSOACs is growing, but challenges remain.

Purpose of the Study:

  • To review current management questions for TSOACs.
  • To provide updated information on periprocedural TSOAC management.
  • To discuss methods for measuring TSOAC effect and compare them with traditional anticoagulants.

Main Methods:

  • Literature review of recent evidence and clinical trial data.
  • Synthesis of information on periprocedural management strategies.
  • Discussion of monitoring techniques and antidote considerations.

Main Results:

  • Updated guidance on periprocedural management of TSOACs is available.
  • Evidence on optimal methods for measuring TSOAC effect is evolving.
  • Key considerations for choosing between TSOACs and traditional anticoagulants are highlighted.

Conclusions:

  • TSOACs present management challenges requiring updated clinical guidance.
  • Further evidence is needed for optimal TSOAC monitoring and periprocedural care.
  • Informed decision-making between TSOACs and traditional anticoagulants is crucial for patient safety.