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Ther Adv Drug Saf. 2014 Feb;5(1):8-20. doi: 10.1177/2042098613507945.

Safety of new oral anticoagulant drugs: a perspective.

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  • 1University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, UK and Department of Cardiology and Department of Clinical Analysis, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain.
  • 2University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, UK and Department of Hematology and Clinical Oncology, Hospital Universitario Morales Meseguer, Murcia, Spain.
  • 3University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Dudley Road, Birmingham B18 7QH, UK.


The recent development of new oral anticoagulants (NOACs) offers the possibility of efficacy, relative safety and convenience compared with warfarin. This could lead to greater patient compliance, with easier management and improved provision of thromboprophylaxis. Safety whilst using NOACs should be focused on bleeding cases, surgery or on the management of patients receiving anticoagulant therapy with concomitant impairment of renal function, especially since many NOACs are dependent on renal excretion. Thus, if the clearance creatinine indicates severe renal impairment, NOACS will be contraindicated or their dose needs to be changed. In patients who need surgery, there are published protocols of management, depending on the severity of the intervention and renal function. In the case of severe hemorrhage, requiring rapid reversal of the anticoagulant effect and in the absence of specific antidotes, alternatives such as one of the nonspecific haemostatic agents must be considered. Clinical evaluation in bleeding situations and a meticulous risk-benefit appraisal for NOACs is needed, and these procoagulant agents and patients must be monitored closely. This article provides an overview of the pharmacology and potential risks, as well as the efficacy and safety of NOACs.


apixaban; bleeding; dabigatran; new oral anticoagulants; rivaroxaban

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