Oral anticoagulation for adults with atrial fibrillation or venous thromboembolism
Research article published in Australian prescriber (2025)
Abstract
Most patients with non-valvular atrial fibrillation (AF) or acute venous thromboembolism (VTE) can be treated with a direct-acting oral anticoagulant (DOAC); currently available DOACs are apixaban, rivaroxaban and dabigatran. Warfarin is the first-line oral anticoagulant for valvular AF in patients with mechanical heart valves or rheumatic mitral stenosis. Apixaban and rivaroxaban are first-line oral anticoagulants for cancer-associated VTE, and for AF or VTE in patients with body mass index over 35 kg/m2 or actual body weight over 120 kg. All DOACs require dose adjustment in people with moderate kidney impairment. Routine laboratory measurement of drug concentrations or relevant coagulation function assays is not required for safe and effective use of DOACs; however, there are situations when it may be beneficial, including emergency scenarios requiring normal haemostasis and where excessive or inadequate anticoagulation is suspected.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Summary
Peer-reviewed clinical and outcomes research relevant to medicinal leech therapy and its biology. Indexed in PubMed and verified against the NCBI record.
Why This Matters for Hirudotherapy
This narrative review summarizes current oral-anticoagulation practice for non-valvular atrial fibrillation and venous thromboembolism, noting that most such patients can be managed with a direct-acting oral anticoagulant (apixaban, rivaroxaban, or dabigatran), that warfarin remains first-line for mechanical valves and rheumatic mitral stenosis, and that routine drug-level monitoring is generally unnecessary for DOACs. For ASH, it maps the modern anticoagulant landscape that any hirudotherapy program must respect: patients on these agents already carry an elevated bleeding profile, which is directly relevant to leech-application screening and the secretome's own anticoagulant peptides. As a review of established clinical practice rather than primary data, it sets context and standard-of-care expectations but does not itself test or evaluate leech therapy.
Citation
Oral anticoagulation for adults with atrial fibrillation or venous thromboembolism.
Chin et al. · Australian prescriber, 2025
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