Oral Anticoagulants

Oral Anticoagulants is a topic covered in the Washington Manual of Medical Therapeutics.

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General Principles

Historically, the vitamin k antagonist warfarin was the oral anticoagulant of choice. However, this required bridging with heparin to avoid rare complications and laboratory monitoring. Additionally, both medications and foods led to significant medication interactions. These concerns led to the development of novel oral anticoagulants (NOACs): direct thrombin inhibitors (dabigatran) and factor Xa antagonists (rivaroxaban, apixaban).

Pathophysiology

  • Warfarin and other vitamin k antagonists inhibits vitamin k epoxide reductase leading to a deficiency of factors II, VII, IX, X, C, and S
  • NOACs either inhibit factor II or Xa

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General Principles

Historically, the vitamin k antagonist warfarin was the oral anticoagulant of choice. However, this required bridging with heparin to avoid rare complications and laboratory monitoring. Additionally, both medications and foods led to significant medication interactions. These concerns led to the development of novel oral anticoagulants (NOACs): direct thrombin inhibitors (dabigatran) and factor Xa antagonists (rivaroxaban, apixaban).

Pathophysiology

  • Warfarin and other vitamin k antagonists inhibits vitamin k epoxide reductase leading to a deficiency of factors II, VII, IX, X, C, and S
  • NOACs either inhibit factor II or Xa

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