Peter Wood, MBBS, MD, MRCP, FRACP, FRCPA, Associate Professor.
New oral anticoagulants: An emergency department overview
Version of Record online: 13 NOV 2013
© 2013 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine
Emergency Medicine Australasia
Volume 25, Issue 6, pages 503–514, December 2013
How to Cite
Wood, P. (2013), New oral anticoagulants: An emergency department overview. Emergency Medicine Australasia, 25: 503–514. doi: 10.1111/1742-6723.12156
- Issue online: 5 DEC 2013
- Version of Record online: 13 NOV 2013
- Manuscript Accepted: 8 OCT 2013
As of September 2013, three new oral anticoagulants (NOACs) are now available for clinical use on the Pharmaceutical Benefits Scheme in Australia. All three are for stroke prevention in atrial fibrillation, and one will also be available for the treatment of deep venous thrombosis and pulmonary embolism. All have been evaluated in large, multicentre randomised clinical trials. These drugs show at least equivalent efficacy to the current standard of care, the vitamin K antagonist warfarin. Major bleeding rates are overall comparable with warfarin, but there is an important reduction in intracranial bleeding of approximately 50% with all NOAC agents. The NOACs are administered in a simple, fixed dose regimen. There are a few clinically important interactions with other medications or diet. Concerns exist about the potential for irreversible bleeding in the small number of patients in which that occurs. This short report will discuss the pharmacology of these agents, the indications for use, aspects of laboratory monitoring and the management of bleeding with these agents.