Abstract
The commercially available non-vitamin K antagonist oral anticoagulants (NOAC) are
an emerging therapeutic class, which includes dabigatran, rivaroxaban, apixaban, and
edoxaban. Dose adjustment of the NOAC currently takes into account the presence of
particular patient characteristics that may alter NOAC concentrations. These characteristics
include the presence of renal impairment and concomitant drugs affecting proteins
involved with the transport and metabolism of the NOAC. NOAC concentrations reflect
anticoagulant activity; some studies have shown some correlation with the risks of
adverse events, while others have not, and the association is debated by workers in
the field. However, dose adjustment based on characteristics before dosing assumes
that the patient has drug oral availability and clearance at the mean of patients
with these characteristics. Direct quantification of NOAC concentrations, for example,
through the use of calibrated coagulation assays, is likely to add further to individualization
of dosing to the particular patient.
Keywords
dabigatran - rivaroxaban - apixaban - edoxaban - dose adjustment - blood coagulation
- monitoring - pharmacokinetics
