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OVERVIEW OF NON-VITAMIN K ORAL ANTICOAGULANTS

IULIA MĂDĂLINA CÎRSTEA ¹, BOGDAN MÎNDRILĂ ¹, EUGEN ȚIERANU ^1*, LOREDANA MARIA ȚIERANU ², OCTAVIAN ISTRĂTOAIE ³, CONSTANTIN MILITARU ³, IONUȚ DONOIU ^1,3

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Clotting is a highly complex process and its excessive activation can lead to major risk events. Therefore, anticoagulant treatment is one of the mainstays of pharmacology. Vitamin K antagonists were the only oral anticoagulants available for more than half a century. In the early 2000s new possibilities emerged in this field. The direct and selective mechanism by which they inhibit clotting factors along with their rapid onset of action, the diminished intra-and interindividual variability, the short half-life, the fact that routine therapeutic drug monitoring is not necessary, their strong antithrombotic effect were the main supporting arguments put forth for the use of the direct anticoagulants. Taking into account their innovative aspect, health practitioners were reluctant to prescribe these new drugs and invoked their main shortcomings, both medical (e.g.: lack of an antidote, higher bleeding risk when impaired renal function, certain prescribing restrictions etc.) and financial ones. Why should a non-vitamin K oral anticoagulant (NOAC) be used instead of a vitamin K antagonist? Which would be the best option among the NOACs? These are the most important questions that need answers, which can be obtained by studying the pharmacologic profile of these drugs.