For over 50 years now, vitamin K antagonists, such as warfarin, have been prescribed as anticoagulants for thrombotic disorders. However, the recent clinical introduction of direct-action oral anticoagulants is predicted to change the landscape of these medicines. These new direct-action oral anticoagulants are most likely to be used in a significant number of patients with atrial fibrillation. They will also be used for other indications such as the prevention of thromboembolism in orthopaedic patients and treatment of acute venous throemboembolism.
The introduction of these new anticoagulants bring about great potential and simplicity; however, they also raise new questions and challenges including the current lack of antidotes in cases of overdose and the possibility of lower adherence. A new thematic series published in Thrombosis Journal, guest edited with Meyer Michel Samama, puts a spotlight on these new anticoagulants.
Patients who take warfarin have to be monitored and their dosage adjusted based on the International Normalized Ratio. The new direct-action oral anticoagulants have a fixed dose, which has mostly removed the need for monitoring. In his introductory editorial, Thrombosis Journal’s co-Editor-in-Chief Hugo ten Cate ask whether fixed dose is the ideal dose, he also addresses the question of adherence to these new drugs.
The series launches with a review article from Armando Tripodi who discusses how in time it will become more important to test for the anticoagulation effects of the new direct-action oral anticoagulants and how these tests can be reported. A second review article by Mueck et al. acknowledges that although close monitoring is not needed for the new group of pharmaceuticals in comparison to vitamin K antagonists there are exceptions such as patients with renal impairment and overdose. Mueck et al. investigate which assays would be most appropriate for monitoring plasma concentrations of these drugs.
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Shane Canning, Journal Development Editor, Thrombosis Journal