Main Research Findings

New oral anticoagulants (NOACs) have emerged as a more effective and safer alternative to traditional vitamin K antagonists (warfarin or acenocumarol). 1 They work differently, don't require constant monitoring, and are considered more effective and safer than vitamin K antagonists. 1 The use of these molecules (Dabigatran, Apixaban, Rivaroxaban, Betrixaban, Edoxaban) is continuously increasing in everyday practice. 1 However, while available data suggest NOAC/DOAC use is safe, dosage adjustments are needed based on kidney or liver function. 1 It's important to note that commonly used blood tests [Prothrombin Time (PT) and partial thromboplastin time (PTT)] are not suitable for monitoring the anticoagulant activity of these compounds. 1 With the exception of dabigatran, we currently lack a specific antidote to reverse the anticoagulant effect of NOAC/DOAC. 1 This article reviews available evidence on NOAC/DOAC pharmacokinetics, risk factors for bleeding, interventions to reverse anticoagulant activity in case of hemorrhages or need for urgent surgery, and/or NOAC/DOAC overdose or side effects. 1

Reasons for Side Effects

NOACs work by inhibiting blood clotting factors. 1 This can increase the risk of bleeding. 1 Additionally, NOACs are metabolized by the kidneys, and if kidney function is impaired, they can accumulate in the body, leading to a higher risk of bleeding. 1 NOACs are also metabolized by the liver, so impaired liver function can also increase the risk of side effects. 1

Common Side Effects

Bleeding

The most common side effect of NOACs is bleeding. 1 Bleeding can occur in the digestive system, brain, or other organs. 1

Gastrointestinal Side Effects

NOACs can cause gastrointestinal side effects. 1 These include stomach pain, diarrhea, and constipation. 1

Liver Side Effects

NOACs can cause liver side effects. 1 These include abnormalities in liver function. 1

Kidney Side Effects

NOACs can cause kidney side effects. 1 These include abnormalities in kidney function. 1

Managing Side Effects

Bleeding

If bleeding occurs, seek immediate medical attention. 1 If the bleeding is severe, treatment such as blood transfusions may be necessary. 1 Idarucizumab can be used to reverse the anticoagulant effects of dabigatran. 1 There is no effective antidote for other NOACs. 1

Gastrointestinal Side Effects

If gastrointestinal side effects occur, consult a doctor. 1 You may need to change medications or implement dietary changes. 1

Liver Side Effects

If liver side effects occur, consult a doctor. 1 You may need to change medications or undergo treatment aimed at improving liver function. 1

Kidney Side Effects

If kidney side effects occur, consult a doctor. 1 You may need to change medications or undergo treatment aimed at improving kidney function. 1

Comparison Between Studies

Commonalities

This article discusses various studies on the safety and efficacy of NOACs. 1 These studies suggest that NOACs are a more effective and safe alternative to traditional vitamin K antagonists. 1

Differences

Research findings may vary depending on the type of NOAC and the disease being treated. 1 For example, the risk of bleeding and the frequency of side effects may differ depending on the NOAC used. 1

Implications for Real-Life Applications

NOACs are considered a more effective and safer alternative to traditional vitamin K antagonists. 1 However, dosage adjustments are needed based on kidney or liver function. 1 Additionally, NOACs carry a higher risk of bleeding. 1 When using NOACs, follow your doctor's instructions carefully and attend regular check-ups. 1

Limitations of Current Research

There is still insufficient research on NOACs. 1 Further research is needed, especially on the long-term safety and effectiveness of NOACs. 1 Developing specific antidotes to reverse the anticoagulant effects of NOACs is also a crucial challenge. 1

Future Research Directions

Further research is needed on the long-term safety and effectiveness of NOACs, the development of specific antidotes to reverse the anticoagulant effects of NOACs, and the individual variability in response to NOACs. 1

Conclusion

NOACs are considered a more effective and safe alternative to traditional vitamin K antagonists. 1 However, they have a higher risk of bleeding. 1 When using NOACs, follow your doctor's instructions carefully and attend regular check-ups. 1