Direct-Acting Oral Anticoagulants: Treatment Considerations

For patients at risk for thromboembolic complications who have trouble with adherence to warfarin therapy or prefer not to be treated with warfarin, newer direct-acting oral anticoagulants may be an option. Michael A. Evans, BS, RPh, explores the advantages and limitations of treating patients with direct-acting oral anticoagulants.

Mr Evans remarks that unlike with warfarin, regular monitoring is not required with the direct-acting oral anticoagulants, as their anticoagulant effect is predictable. There are no known food interactions with the direct-acting oral anticoagulants; however, drug-drug interactions are still of concern.

The direct-acting oral anticoagulants have a short half-life, and thus missed doses and a lack of patient adherence leave patients at risk for thromboembolic events within a short time frame, says Mr Evans.

Should a patient who is being treated with a direct-acting oral anticoagulant experience a thromboembolic event, it is more difficult to determine whether the event was related to a lack of adherence or drug failure, notes Mr Evans. This may be easier to determine for patients who are treated with warfarin, he adds.

Mr Evans explains that a patient’s age, their risk for bleeding events, and cost are all factors that affect a physician’s decision to treat a patient with warfarin versus a direct-acting oral anticoagulant.