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Transitions of care in anticoagulated patients

Authors Michota F

Received 15 February 2013

Accepted for publication 16 April 2013

Published 20 June 2013 Volume 2013:6 Pages 215—228

DOI https://doi.org/10.2147/JMDH.S44068

Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 3

Franklin Michota

Department of Hospital Medicine, Cleveland Clinic, Cleveland, OH, USA

Abstract: Anticoagulation is an effective therapeutic means of reducing thrombotic risk in patients with various conditions, including atrial fibrillation, mechanical heart valves, and major surgery. By its nature, anticoagulation increases the risk of bleeding; this risk is particularly high during transitions of care. Established anticoagulants are not ideal, due to requirements for parenteral administration, narrow therapeutic indices, and/or a need for frequent therapeutic monitoring. The development of effective oral anticoagulants that are administered as a fixed dose, have low potential for drug-drug and drug-food interactions, do not require regular anticoagulation monitoring, and are suitable for both inpatient and outpatient use is to be welcomed. Three new oral anticoagulants, the direct thrombin inhibitor, dabigatran etexilate, and the factor Xa inhibitors, rivaroxaban and apixaban, have been approved in the US for reducing the risk of stroke and systemic embolism in patients with nonvalvular atrial fibrillation; rivaroxaban is also approved for prophylaxis and treatment of deep vein thrombosis, which may lead to pulmonary embolism in patients undergoing knee or hip replacement surgery. This review examines current options for anticoagulant therapy, with a focus on maintaining efficacy and safety during transitions of care. The characteristics of dabigatran etexilate, rivaroxaban, and apixaban are discussed in the context of traditional anticoagulant therapy.

Keywords: hemorrhagic events, oral anticoagulation, parenteral anticoagulation, stroke, transitions of care

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