Pharmacokinetics and Pharmacodynamics of DOAC

Direct oral anticoagulants (DOACs) have become available as an alternative to warfarin anticoagulation in non-valvular atrial fibrillation. The DOACs, dabigatran (a reversible direct thrombin inhibitor) and the direct factor Xa inhibitors rivaroxaban, apixaban, and edoxaban offer fixed dosing, more predictable pharmacokinetics and fewer interactions with drugs and food than warfarin. Results from clinical trials demonstrated an improved benefit-risk ratio, compared to warfarin, in a broad patient population. However, significant differences between the four DOACs in terms of pharmacokinetic and safety profile are observed and must be considered to personalize the therapy.Thus, in the present chapter are described the pharmacodynamic and pharmacokinetic characteristics of DOACs, parameters that can help to differentiate their use based on the patient’s characteristics. Such condition should also guide clinicians to prescribe the appropriate type and dosage of DOAC, without the laboratory monitoring of their anticoagulant activity.KeywordsPharmacokineticPharmacodynamicP-gpCYP450ADMEDabigatranRivaroxabanApixabanEdoxaban