Vitamin K antagonists (eg, warfarin) have been the standard of care for stroke prophylaxis in atrial fibrillation. The direct oral anticoagulants dabigatran (direct thrombin inhibitor) and rivaroxaban, apixaban, and edoxaban (direct factor Xa inhibitors) are as efficacious as and in some instances superior to vitamin K antagonists in the prevention of stroke, systemic embolism, and major bleeding compared with warfarin for nonvalvular atrial fibrillation. Benefits of direct oral anticoagulants include a rapid onset of therapeutic effect, fixed dose-response relationships without the need for routine monitoring, a short half-life, and infrequent need for periprocedural bridging with a parenteral agent. However, direct oral anticoagulants differ in subsets of patients. Critical care and advanced practice nurses must understand these differences, prescribing considerations, drug aherence interventions, drug-drug interactions, and periprocedural management. This article presents an update and review of direct oral antigcoagulants based on the latest national guidelines.
Advanced Practice| April 01 2019
Direct Oral Anticoagulants in Patients With Nonvalvular Atrial Fibrillation: Update and Periprocedural Management
Joya D. Pickett, PhD, RN, ARNP-CNS, CCNS, ACNS-BC, CCRN
Joya Pickett is a critical care clinical nurse specialist at Swedish Medical Center, Seattle, Washington.
Corresponding author: Joya D. Pickett, phd, rn, arnp-cns, ccns, acns-bc, ccrn, Swedish Medical Center, 747 Broadway, Seattle, WA 98122 (email: firstname.lastname@example.org or email@example.com).
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Crit Care Nurse (2019) 39 (2): 54–67.
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Joya D. Pickett; Direct Oral Anticoagulants in Patients With Nonvalvular Atrial Fibrillation: Update and Periprocedural Management. Crit Care Nurse 1 April 2019; 39 (2): 54–67. doi: https://doi.org/10.4037/ccn2019292
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