Direct new oral anticoagulants in the emergency department: Experience in everyday clinical practice at a Swiss university hospital

Published:January 05, 2016DOI:
      Since 2009, an increasing number of patients presenting to emergency departments (ED) are on anticoagulant medication with the newer direct oral anticoagulants (NOAC), such as rivaroxaban (Xarelto), apixaban (Eliquis), and dabigatran (Pradaxa). Important advantages of these agents are easier therapy management, faster onset of therapeutic effect, and an increasing range of approved indications in comparison to the classic Vitamin-K antagonists (VKA) such as warfarin and phenprocoumon (Marcoumar). Major concerns in the treatment of patients on all anticoagulant medication are bleeding events.


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        • Chai-Adisaksopha C.
        • Hillis C.
        • Isayama T.
        • Lim W.
        • Iorio A.
        • Crowther M.
        Mortality outcomes in patients receiving direct oral anticoagulants: a systematic review and meta-analysis of randomized controlled trials.
        J Thromb Haemost. 2015; 13: 2012-2020
        • Southworth M.R.
        • Reichman M.E.
        • Unger E.F.
        Dabigatran and postmarketing reports of bleeding.
        N Engl J Med. 2013; 368: 1272-1274
        • Harel Z.
        • Sholzberg M.
        • Shah P.S.
        • Pavenski K.
        • Harel S.
        • Wald R.
        • et al.
        Comparisons between novel oral anticoagulants and vitamin K antagonists in patients with CKD.
        J Am Soc Nephrol. 2014; 25: 431-442
        • Kumar S.
        • Danik S.B.
        • Altman R.K.
        • Barrett C.D.
        • Lip G.Y.
        • Chatterjee S.
        • et al.
        Non-VKA oral anticoagulants and antiplatelet therapy for stroke prevention in patients with atrial fibrillation: a meta-analysis of randomized controlled trials.
        Cardiol Rev. Aug 11 2015; ([Epub ahead of print])
        • Held C.
        • Hylek E.M.
        • Alexander J.H.
        • Hanna M.
        • Lopes R.D.
        • Wojdyla D.M.
        • et al.
        Clinical outcomes and management associated with major bleeding in patients with atrial fibrillation treated with apixaban or warfarin: insights from the ARISTOTLE trial.
        Eur Heart J. 2015; 36: 1264-1272
        • Dans A.L.
        • Connolly S.J.
        • Wallentin L.
        • Yang S.
        • Nakamya J.
        • Brueckmann M.
        • et al.
        Concomitant use of antiplatelet therapy with dabigatran or warfarin in the Randomized Evaluation of Long-Term Anticoagulation Therapy (RE-LY) trial.
        Circulation. 2013; 127: 634-640
        • Van der Hulle T.
        • Kooiman J.
        • den Exter P.L.
        • Dekkers O.M.
        • Klok F.A.
        • Huisman M.V.
        Effectiveness and safety of novel oral anticoagulants as compared with vitamin K antagonists in the treatment of acute symptomatic venous thromboembolism: a systematic review and meta-analysis.
        J Thromb Haemost. 2014; 12: 320-328
        • Gómez-Outes A.
        • Terleira-Fernández A.I.
        • Lecumberri R.
        • Suárez-Gea M.L.
        • Vargas-Castrillón E.
        Direct oral anticoagulants in the treatment of acute venous thromboembolism: a systematic review and meta-analysis.
        Thromb Res. 2014; 134: 7747-7782
        • Granger C.B.
        • Alexander J.H.
        • McMurray J.J.
        • Lopes R.D.
        • Hylek E.M.
        • Hanna M.
        • et al.
        ARISTOTLE Committees and Investigators. Apixaban versus warfarin in patients with atrial fibrillation.
        N Engl J Med. 2011; 365: 981-992
        • Patel M.R.
        • Mahaffey K.W.
        • Garg J.
        • Pan G.
        • Singer D.E.
        • Hacke W.
        • et al.
        ROCKET AF Investigators. Rivaroxaban versus warfarin in nonvalvular atrial fibrillation.
        N Engl J Med. 2011 Sep 8; 365: 883-891