This article interested me right from the start because the title involved anticoagulation. Anticoagulation is a huge part of pharmacy and its management is essential for those with a history of cardiac events. Newer oral anticoagulation drugs or non-Vitamin K oral antagonists (NOAC) directly inhibit factor Xa. These drugs have simpler dosing regimens and do not require frequent INR values for monitoring. Their downside though, is the lack of reversal agents. Although, this issue was partially solved by the FDA with the approval of a monoclonal antibody product that has the capability to reverse the effects of a common NOAC: dabigatran. A clinical pharmacist at the University of Utah College of Pharmacy thinks it’s important to note that even without a reversal agent, patients that suffer from bleeding episodes as a result of anticoagulation therapy are better off on these newer agents rather than something more traditional like warfarin. The coordination of care as well as the fact that INR monitoring is not necessary is another positive to NOACs. What are your thoughts? Should we begin to make the transition from warfarin to newer drugs as the first line therapy for patients in need of anticoagulation? What about switching patients that are already receiving warfarin? Are there potential risks to changing drug therapy in this sense? My thoughts include keeping patients on the medications that they’ve been the most compliant or successful with. If a patient doesn’t mind having their INR levels checked and they haven’t had any trouble with warfarin I think it would make the most sense to keep the patient on this medication.
Kearon C, Akl E, Ornelas J. Antithrombotic Therapy for VTE Disease: CHEST Guideline and Expert Panel Report. Chest. 2016; 149(2):315-52.