Full Text
Abstract
Summury. A review of foreign and domestic literature devoted to recent studies of the effectiveness and safety of direct oral anti- coagulants (DOACs) use in patients with a high risk of hemorrhagic complications is presented. We analyzed data from studies on DOACs use, in particular, the factor Xa inhibitor rivaroxaban in patients with atrial fibrillation (AF) and non-modifiable risks of hemorrhagic complications: impaired liver and kidney function, oncological diseases, a history of stroke, type 2 diabetes mellitus (DM-2) or cognitive disorders. This review highlights the difficulties that practitioners often face in prescribing DOACs to patients with comorbid pathology. The proportion of patients with cognitive impairment/dementia is increasing due to lifetime increasing and appearance of more elderly patients with comorbidities taking DOACs. The choice of dose, as well as the decision to reinitiate anticoagulant therapy, is also of great importance in patients after acute cerebrovascular accident. The increase of patient number with AF and suffering at the same time from oncological diseases, liver diseases and DM-2 also causes to think about the optimal choice of anticoagulant therapy. The review presents the results of studies and key approaches to prescribing DOACs in general and rivaroxaban in particular to patients with AF and comorbidities. DOACs have a good safety and efficacy profile compared to warfarin in patients with AF and high non-modifiable risks of hemorrhagic complications.