Direct Oral Anticoagulants in the Treatment of Venous Thromboembolism: Use in Patients with Advanced Renal Impairment, Obesity, or Other Weight-Related Special Populations

Paul P. Dobesh; Molly M. Kernan; Jenni J. Lueshen

doi:10.1055/s-0041-1723952

Seminars in Respiratory and Critical Care Medicine, Inhaltsverzeichnis

Semin Respir Crit Care Med 2021; 42(02): 233-249
DOI: 10.1055/s-0041-1723952

Review Article

Direct Oral Anticoagulants in the Treatment of Venous Thromboembolism: Use in Patients with Advanced Renal Impairment, Obesity, or Other Weight-Related Special Populations

Paul P. Dobesh

¹College of Pharmacy, University of Nebraska Medical Center, Nebraska Medical Center, Omaha, Nebraska

,

Molly M. Kernan

¹College of Pharmacy, University of Nebraska Medical Center, Nebraska Medical Center, Omaha, Nebraska

,

Jenni J. Lueshen

¹College of Pharmacy, University of Nebraska Medical Center, Nebraska Medical Center, Omaha, Nebraska

› Institutsangaben

Abstract

There are currently more than 7 million patients taking a direct oral anticoagulant (DOAC), with more new prescriptions per year than warfarin. Despite impressive efficacy and safety data for the treatment of venous thromboembolism, patients with obesity or advanced renal impairment represented a small portion of the patients enrolled in the phase 3 clinical trials. Therefore, to evaluate the potential use of DOACs in these special populations, clinicians need to have an understanding of the pharmacokinetics and pharmacodynamics of these agents in these settings. Since data from randomized controlled trials are limited, data from observational trials are helpful in gaining comfort with the use of DOACs in these special populations. Selecting the appropriate dose for each agent is imperative in achieving optimal patient outcomes. We provide an extensive review of the pharmacokinetics, pharmacodynamics, phase 3 clinical trials, and observational studies on the use of DOACs in patients with advanced renal impairment, obesity, or other weight-related special populations to provide clinicians with a comprehensive understanding of the data for optimal drug and dose selection.

Keywords

DOAC - NOAC - obesity - venous thromboembolism - renal impairment - renal dysfunction

Volltext

Referenzen

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