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Pharmacokinetic drug interactions of the non-vitamin K antagonist oral anticoagulants (NOACs)

Published on Sep 1, 2018in Pharmacological Research5.574
· DOI :10.1016/j.phrs.2018.07.016
Paolo Gelosa23
Estimated H-index: 23
,
Laura Castiglioni10
Estimated H-index: 10
(University of Milan)
+ 4 AuthorsStefano Bellosta26
Estimated H-index: 26
(University of Milan)
Sources
Abstract
Abstract The use of warfarin, the most commonly prescribed oral anticoagulant, is being questioned by clinicians worldwide due to warfarin several limitations (a limited therapeutic window and significant variability in dose-response among individuals, in addition to a potential for drug-drug interactions). Therefore, the need for non-vitamin K antagonist oral anticoagulants (NOACs) with a rapid onset of antithrombotic effects and a predictable pharmacokinetic (PK) and pharmacodynamic (PD) profile led to the approval of five new drugs: the direct factor Xa (F-Xa) inhibitors rivaroxaban, apixaban, edoxaban and betrixaban (newly approved by FDA) and the direct thrombin (factor-IIa) inhibitor dabigatran etexilate. The advantages of NOACs over warfarin are a fixed-dosage, the absence of the need for drug monitoring for changes in anti-coagulation and fewer clinically significant PK and PD drug–drug interactions. NOACs exposure will likely be increased by the administration of strong P-glycoprotein (P-gp) and cytochrome P450 (CYP) 3A4-inhibitors and may increase the risk of bleeds. On the contrary, P-gp inducers could significantly decrease the NOACs plasma concentration with an associated reduction in their anticoagulant effects. This manuscript gives an overview of NOACs PK profiles and their drug-drug interactions potential. This is meant to be of help to physicians in choosing the best therapeutic approach for their patients.
  • References (165)
  • Citations (8)
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References165
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Background:Despite dual antiplatelet therapy, persistent thrombin generation and thrombin-mediated platelet activation account in part for the residual risk of atherothrombotic disease among patients with prior acute coronary syndrome (ACS). Inhibition of thrombin generation among high-risk ACS patients (biomarker-positive ACS) with the factor Xa inhibitor rivaroxaban may limit ongoing thrombus formation and myocardial necrosis and thereby improve clinical outcomes.Objectives and methods:ATLAS A...
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[Steffel, Jan] Univ Heart Ctr Zurich, Dept Cardiol, Ramistr 100, CH-8091 Zurych, Switzerland. [Verhamme, Peter; Sinnaeve, Peter] Univ Leuven, Dept Cardiovasc Sci, Leuven, Belgium. [Potpara, Tatjana S.] Univ Belgrade, Sch Med, Belgrad, Serbia. [Albaladejo, Pierre] Grenoble Alps Univ Hosp, Grenoble, France. [Antz, Matthias] City Hosp Braunschweig, Braunschweig, Germany. [Desteghe, Lien; Heidbuchel, Hein] Hasselt Univ, Fac Med & Life Sci, Hasselt, Belgium. [Haeusler, Karl Georg] Charite, Ctr Stroke...
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