The ability to understand how to optimally achieve anticoagulation with warfarin took 60 years since its approval by the US Food and Drug Administration (FDA) in 1954. How long will it take clinicians to understand how to optimally dose the new thrombin and factor Xa inhibitors in all patients?
The rapidly emerging new direct-acting oral anticoagulants (DOACs), including dabigatran, rivaroxaban, apixaban, and edoxaban, have been found noninferior or superior to individualized warfarin dosing in preventing stroke, while causing similar or less risk of hemorrhage.1 These drugs have several common features: 1 dose for all patients (age, renal function adjustments), no need for routine laboratory testing, rapid onset and decay of anticoagulant activity when dosing is started and stopped, and fewer interactions (eg, with food or drugs).
Powell JR. Are New Oral Anticoagulant Dosing Recommendations Optimal for All Patients? JAMA. 2015;313(10):1013–1014. doi:10.1001/jama.2015.59
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