Italian intersociety consensus on DOAC use in internal medicine

作者：Prisco Domenico; Ageno Walter; Becattini Cecilia; D%apos; Angelo Armando; Davi Giovanni; De Cristofaro Raimondo; Dentali Francesco; Di Minno Giovanni; Falanga Anna; Gussoni Gualberto; Masotti Luca; Palareti Gualtiero; Pignatelli Pasquale; Santi Roberto M; Santilli Francesca; Silingardi Mauro; Tufano Antonella; Violi Francesco

来源：Internal and Emergency Medicine, 2017, 12(3): 387-406.

DOI：10.1007/s11739-017-1628-6

• Atrial fibrillation
• Venous thromboembolism
• Pulmonary embolism
• Venous thrombosis
• Internist
• Drug interactions
• Elderly
• Direct oral anticoagulant
• Novel oral anticoagulant

The direct oral anticoagulants (DOACs) are drugs used in clinical practice since 2009 for the prevention of stroke or systemic embolism in non-valvular atrial fibrillation, and for the treatment and secondary prevention of venous thromboembolism. The four DOACs, including the three factor Xa inhibitors (rivaroxaban, apixaban and edoxaban) and one direct thrombin inhibitor (dabigatran) provide oral anticoagulation therapy alternatives to Vitamin K antagonists (VKAs). Despite their clear advantages, the DOACs require on the part of the internist a thorough knowledge of their pharmacokinetic and pharmacodynamic characteristics to ensure their correct use, laboratory monitoring and the appropriate management of adverse events. This document represents a consensus paper on the use of DOACs by representatives of three Italian scientific societies: the Italian Society of Internal Medicine (SIMI), the Federation of the Associations of Hospital Managers (FADOI), and the Society for the Study of Haemostasis and Thrombosis (SISET). This document formulates expert opinion guidance for pragmatic managing, monitoring and reversing the anticoagulant effect of DOACs in both chronic and emergency settings. This practical guidance may help the internist to create adequate protocols for patients hospitalized ion internal medicine wards, where patients are often elderly subjects affected by poly-morbidities and renal insufficiency, and, thus, require particular attention to drug-drug interactions and peri-procedural protocols.

• 出版日期2017-4