Pharmacokinetics of new oral anticoagulants: implications for use in routine care

Introduction: Since 2008, new oral anticoagulants (NOACs) have been approved for the prevention of venous thromboembolism (VTE) in patients receiving hip or knee replacement surgery, prevention of stroke and systemic embolism in patients with non-valvular atrial fibrillation (NVAF), treatment of deep vein thrombosis (DVT) and pulmonary embolism (PE). Pre-marketing randomized clinical trials of NOACs demonstrated their non-inferiority in terms of efficacy vs. warfarin (traditional oral anticoagulant – TOA), with lower risk of serious adverse drug reactions, especially cerebral haemorrhages. In clinical practice, pharmacokinetic aspects of NOACs have to be carefully taken into account to optimize the benefit-risk profile of these drugs. Areas covered: An overview of major issues related to pharmacokinetics of NOACs, such as drug-drug interactions, over- and under-dosage in special populations (e.g. elderly, underweight and patients with chronic kidney disease patients), and impact on adherence and persistence to NOACs therapy and ultimately clinical outcomes in real world setting is provided. Expert Opinion: NOACs have been proven to be a better option than traditional anticoagulants due to better tolerability and ease of use. However, given specific pharmacokinetic characteristics, NOACs therapy has to be carefully tailored and monitored in relation to patients’ characteristics with the final goal to maximize benefits and minimize risks.