Long-term prescribing of new oral anticoagulants

Abstract

Warfarin and the new oral anticoagulants are licensed for non-valvular atrial fibrillation and venous thromboembolism. The choice of anticoagulant depends on the characteristics of the patient and the medicine. Key considerations include patient adherence, kidney and liver function, and potential interactions with concomitant drugs. Dosing should accommodate these factors. Patients should be regularly monitored for bleeding, adherence to treatment, and changing comorbidities and concomitant drugs. Renal function should be checked at least annually. Other than idarucizumab for dabigatran, there are no widely available antidotes for the new oral anticoagulants. In a patient with normal renal and hepatic function, drug concentrations and anticoagulant effect are expected to diminish by over 90% after stopping treatment for 48 hours