Pharmacologic Considerations for New Oral Anticoagulants

“Careful and considerate prescribing is crucial—you’re not giving chocolates to patients, you are giving powerful anticoagulants. They will work well if you give them correctly and use them appropriately. --Gregory Lip, MD

The American College of Cardiology 62nd Annual Scientific Session & Expo featured a daylong program on advances in pharmacology. One session in particular, "Pharmacologic Considerations with the New Oral Anticoagulants," focused on the importance of individualized therapy when it comes to selecting antithrombotic therapy for atrial fibrillation.

Presenter David Parra, PharmD, FCCP, BCPS, Clinical Pharmacy Specialist, Cardiology West Palm Beach Veterans Affairs Medical Center, Clinical Associate Professor, Department of Experimental and Clinical Pharmacology College of Pharmacy, Universtiy of Minnesota, included the above quotation in his presentation to remind attendees of the seriousness of anticoagulants and how there can be serious repercussions if not properly used. There are many variables to consider when prescribing anticoagulants, such as drug-specific properties like reversibility, half-life, and storage requirements.

A majority of Dr Parra’s presentation focused on case studies and pivotal clinical trails that are being conducted with new oral anticoagulants. Dr Parra did an admirable job in presenting various patient cases and then recommending an appropriate oral anticoagulant based on the characteristics of each patient, addressing important drug-drug interactions and how to avoid overdose and bleeding along the way.

“New anticoagulants have emerged that allow options for the prevention of stroke and embolism in nonvalvular atrial fibrillation,” said Dr Parra, adding that it is important to evaluate each patient individually in order to tailor a therapy that works best for them. In doing so, there is less risk for drug-drug interactions, a similar or less bleeding rate as compared to warfarin, and efficacy remains equal or, in some cases, better by comparison. Dr Parra did note, however, that there are disadvantages to anticoagulants as well, such as unknown individual anticoagulant effect, lack of reversal agents, unknown side effects, and concerns with renal dysfunction.

Anticoagulants, though not perfect, offer healthcare providers and opportunity to tailor treatments while adding benefits not available through other treatment regimens. However, these treatments are very powerful, and healthcare providers must do their due diligence in order to ensure patient safety.