The use of direct oral anticoagulants: Focus on dosing schedule and net clinical benefit
https://doi.org/10.21518/ms2025-558
Abstract
Evaluation of the net clinical benefit of anticoagulant therapy is an important tool that helps compare thromboembolic and hemorrhagic risks. The net clinical benefit of direct oral anticoagulants (DOACs) exceeds that of warfarin and demonstrates their significant advantage in various patient categories. The dosing schedule of DOACs (once or twice daily) influences peak plasma drug concentrations and continuity of their action, which is particularly important if a patient misses or takes an extra dose incidentally. Twice daily dosing of DOACs may be safer due to less variability in drug concentrations and, according to some data, has a more favorable net clinical benefit profile determined by both thrombotic and hemorrhagic risks. Different DOACs have their own pharmacokinetic properties and interand intra-individual variability in plasma concentrations. It should be considered that the degree of factor Xa inhibition is not only influenced by the administration schedule, dosage, and characteristics of the drug, but also by the phenotypic characteristics of the patients. Further studies exploring the personalized approach to anticoagulant therapy appear promising. Patient adherence to DOACs is determined by multiple factors and, according to current data, varies between medications for once-daily (QD) vs. twice-daily (BID) dosing, which suggests more of a role of the molecule itself and its associated tolerability and side effects. Apixaban has demonstrated the greatest clinical benefit for patients with atrial fibrillation, both in randomized controlled trials and in real-world clinical practice, due to the greatest reduction in the risk of major hemorrhagic complications.
About the Authors
E. A. Medvedeva
Almazov National Medical Research Centre
Russian Federation
Russian Federation
Elena А. Medvedeva, Cand. Sci. (Med.), Head of the Department of Strategic Development of Cardiology Services in the Regions of the Office for the Implementation of Federal Projects, Associate Professor of the Department of Cardiology, Faculty of Postgraduate and Continuing Education, Institute of Medical Education
2, Akkuratov St., St Petersburg, 197341
S. V. Villevalde
Almazov National Medical Research Centre
Russian Federation
Russian Federation
Svetlana V. Villevalde, Dr. Sci. (Med.), Professor, Head of the Analysis and Long-term Planning Service of the Office for the Implementation of Federal Projects, Head of the Department of Cardiology, Faculty of Postgraduate and Additional Education, Institute of Medical Education
2, Akkuratov St., St Petersburg, 197341
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For citations:
Medvedeva EA, Villevalde SV. The use of direct oral anticoagulants: Focus on dosing schedule and net clinical benefit. Meditsinskiy sovet = Medical Council. 2025;(23):18-24. (In Russ.) https://doi.org/10.21518/ms2025-558
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