Clinico-pharmacological aspects of using new oral anticoagulants in patientswith atrial fibrillation
The review focuses on pharmacokinetic features of new oral anticoagulants (NOAK), dabigatran, rivaroxaban, apixaban, and edoxaban; principles of choosing dosing regimens for these drugs in phase 3 clinical studies in patients with atrial fibrillation (AF); practical aspects of using the drugs; dose adjustment based on the patient’s profile; and approaches to individualized choice of anticoagulants. It was shown that the NOAC dosing frequency can be driven by the required degree of anticoagulation, effect duration, interrelation between the highest and the lowest steady-state concentrations and efficacy and safety. Using some anticoagulants once daily not only can provide better compliance with the therapy but also can reduce the risk of bleeding. Results of NOAC studies in real-life clinical practice have demonstrated a high level of compliance with the once daily dosing regimen. Considering the fact that the incidence of bleeding in real-life clinical practice does not exceed that in clinical studies special attention to the patients’ compliance with the treatment is justified by safety of the anticoagulant therapy.