Introduction and Overview of Direct Oral Anticoagulants

Cardiovascular panel of experts provide an overview and mechanism of action for the direct oral anticoagulants.

Jessica Kerr, PharmD, CDE: Hello and welcome to this Pharmacy Times® Practice Pearls, best practices for the use of direct oral anticoagulants in obesity. I am Dr. Jessica Kerr, associate dean and professor at Southern Illinois University, Edwardsville School of Pharmacy in Edwardsville, Illinois. Joining me today in this virtual discussion are Dr. Paul Dobesh, professor of pharmacy practice and science at the College of Pharmacy from the University of Nebraska Medical Center in Omaha, Nebraska. And Dr. Matthew Johnson, cardiologist at Bryan Health in Lincoln, Nebraska. Today, we are going to provide an overview for the drug classes of the direct oral anticoagulants, provide definitions of obesity. To start on the same page, that will allow us to dive into the clinical data to support our proposed clinical practice pearls, to better understand the use of direct oral anticoagulants in the obese population. It will also be helpful to identify barriers and treatments and to learn from our guest speakers ways that one may overcome the barriers when it comes to this population. So, gentlemen, if you're ready, we'll get started on our first topic.

Let's start first with a general background. Dr Johnson, can you share with us the mechanism of actions surrounding direct oral anticoagulants that allow for the success in combating the coagulation process to help our patients.

Matthew Johnson, MD: Now, the mechanism of action of direct oral anticoagulants are really broken down into the Xa inhibitors, which are what we'll talk about here in a little bit as well as one, a direct thrombin inhibitor. The mechanism of action is very pinpointed and directed at 1 molecule rather than warfarin, or Coumadin, which may affect multiple factors. The mechanism of action is going to be directed to factor Xa inhibition via direct oral anticoagulants, except for dabigatran, which is a direct thrombin inhibitor or a factor IIa inhibitor.