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Direct Oral Anticoagulants in Special Patient Populations
Asa Kessler1, Yotam Kolben1, Gal Puris2
1Heart Institute, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9112002, Israel.
Journal of Clinical Medicine
|January 11, 2024
Summary
Direct oral anticoagulants (DOACs) are widely used for atrial fibrillation but pose risks in specific groups. This review covers safe DOAC use in patients with kidney disease, the elderly, and those with drug interactions or extreme body mass.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Anticoagulants are essential for managing atrial fibrillation.
- Direct oral anticoagulants (DOACs) are increasingly preferred in developed nations.
- Certain patient groups may not be suitable for standard DOAC therapy.
Purpose of the Study:
- To review recommendations for DOAC use in special patient populations.
- To address challenges in prescribing DOACs for individuals with specific comorbidities or risk factors.
Main Methods:
- A fictional case-based approach is utilized.
- Recommendations for DOAC use in challenging patient scenarios are discussed.
Main Results:
- DOAC treatment may be inappropriate in patients with chronic kidney disease, leading to elevated concentrations.
- Frail elderly patients, individuals with significant drug-drug interactions (DDIs), and those at extremes of body mass require careful DOAC consideration.
- Patients with recurrent stroke or major hemorrhage necessitate individualized anticoagulation strategies.
Conclusions:
- Careful patient selection and individualized treatment plans are crucial for safe and effective anticoagulation in atrial fibrillation.
- Understanding the limitations and risks associated with DOACs in special populations is vital for optimizing patient outcomes.
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