Italian intersociety consensus on DOAC use in internal medicine.

Abstract

The direct oral anticoagulants (DOACs) are drugs used in clinical practice since 2009 for the prevention of stroke or systemic embolism in non-valvular atrial fibrillation, and for the treatment and secondary prevention of venous thromboembolism. The four DOACs, including the three factor Xa inhibitors (rivaroxaban, apixaban and edoxaban) and one direct thrombin inhibitor (dabigatran) provide oral anticoagulation therapy alternatives to Vitamin K antagonists (VKAs). Despite their clear advantages, the DOACs require on the part of the internist a thorough knowledge of their pharmacokinetic and pharmacodynamic characteristics to ensure their correct use, laboratory monitoring and the appropriate management of adverse events. This document represents a consensus paper on the use of DOACs by representatives of three Italian scientific societies: the Italian Society of Internal Medicine (SIMI), the Federation of the Associations of Hospital Managers (FADOI), and the Society for the Study of Haemostasis and Thrombosis (SISET). This document formulates expert opinion guidance for pragmatic managing, monitoring and reversing the anticoagulant effect of DOACs in both chronic and emergency settings. This practical guidance may help the internist to create adequate protocols for patients hospitalized ion internal medicine wards, where patients are often elderly subjects affected by poly-morbidities and renal insufficiency, and, thus, require particular attention to drug-drug interactions and peri-procedural protocols.

• Authors: Domenico Prisco, Walter Ageno, Cecilia Becattini, Armando D'Angelo, Giovanni Davì, Raimondo De Cristofaro, Francesco Dentali, Giovanni Di Minno, Anna Falanga, Gualberto Gussoni, Luca Masotti, Gualtiero Palareti, Pasquale Pignatelli, Roberto M Santi, Francesca Santilli, Mauro Silingardi, Antonella Tufano, Francesco Violi, SIMI (Italian Society of Internal Medicine), FADOI (Federation of Associations of Hospital Doctors on Internal Medicine), SISET (Italian Society for the Study of Haemostasis and Thrombosis)
• Journal: Internal and emergency medicine (Intern Emerg Med) Vol. 12 Issue 3 Pg. 387-406 (Apr 2017) ISSN: 1970-9366 [Electronic] Italy
• PMID: 28191610 (Publication Type: Journal Article)

Chemical References

• Anticoagulants
• Antithrombins
• Factor Xa Inhibitors
• Pyrazoles
• Pyridines
• Pyridones
• Thiazoles
• apixaban
• Rivaroxaban
• Dabigatran
• edoxaban

Topics

• Administration, Oral
• Anticoagulants (adverse effects, pharmacology, therapeutic use)
• Antithrombins (pharmacology, therapeutic use)
• Atrial Fibrillation (drug therapy)
• Clinical Competence (standards)
• Consensus
• Dabigatran (pharmacology, therapeutic use)
• Drug-Related Side Effects and Adverse Reactions
• Factor Xa Inhibitors (therapeutic use)
• Food-Drug Interactions
• Humans
• Internal Medicine (methods)
• Italy
• Liver Diseases (etiology)
• Perioperative Period (methods)
• Pyrazoles (pharmacology, therapeutic use)
• Pyridines (pharmacology, therapeutic use)
• Pyridones (pharmacology, therapeutic use)
• Rivaroxaban (pharmacology, therapeutic use)
• Stroke (drug therapy)
• Thiazoles (pharmacology, therapeutic use)
• Time Factors
• Venous Thromboembolism (prevention & control)