Direct Oral Anticoagulants therapy in Iran

Direct Oral Anticoagulants therapy in Iran
Saba Seifpour,¹ Akbar Dorgalaleh,^2,* Peyman Beigi,³ Mahdi Pakjoo,⁴ Masoud Eslami,⁵ Sanaz Khaseb,⁶
1. Department of Hematology, Faculty of Medical Sciences, Tarbiat Modares University (TMU), Tehran, Iran
2. Department of Hematology and Blood Banking, Faculty of Allied Medicine, Iran University of Medical Sciences, Tehran, Iran
3. Department of Hematology, Faculty of Medical Sciences, Tarbiat Modares University (TMU), Tehran, Iran
4. Department of Hematology, Faculty of Medical Sciences, Tarbiat Modares University (TMU), Tehran, Iran
5. Department of Hematology, Faculty of Medical Sciences, Tarbiat Modares University (TMU), Tehran, Iran
6. Department of Hematology, Faculty of Medical Sciences, Tarbiat Modares University (TMU), Tehran, Iran
Introduction: Thrombosis and bleeding are two sides of the double-edged sword of hemostasis. Bleeding disorders are associated with a high rate of morbidity and mortality. Management of thrombosis and bleeding has improved significantly in recent years. Advancements in recombinant coagulation factors synthesis have made a breakthrough in the management of the bleeding disorders and has made significant changes in affected patients’ life quality. On the other side, with the advent of new anticoagulants, prophylaxis, and management of thrombotic events, as a leading cause of morbidity and mortality, has both improved significantly. Direct thrombin inhibitors (DTIs) and factor Xa inhibitors (FXIs), known as direct oral anticoagulants (DOACs), have a growing role in the management of thromboembolic disorders.
Methods: Search by keywords Anticoagulation therapy, DOAC, Thrombosis management in Iran, DOAC therapy advantages,Clinical use and laboratory testing of oral anticoagulation therapy, Reversal of Anticoagulation,... in databases including PubMed, EMBASE, the World Health Organization Index Medicus for the Eastern Mediterranean Region (IMEMR WHO), Ebsco, Science Citation Index Expanded, Ovid, Google Scholar and Scopus.
Results: We reviewed related articles in these subjects which had evaluated DOAC therapy in Iran and results showed that Like most countries worldwide, in Iran, as a Middle East country, all types of anticoagulants including VKAs, heparin, and DOACs are available for management of the patients with thromboembolic disorders. Although the use of DOACs has increased in the recent years, their prescription varies between different countries. The use of DOACs, notably rivaroxaban is increasing in recent years in Iran. Apixaban has been reported as the most common DOACs in North-European and Latin American countries, but is the second most common FXa inhibitor prescribed in Iran. Routine use of DOACs, particularly rivaroxaban, can increase the prescription cost of anticoagulation therapy from 20 to 80 times in Iran. Specific antidotes of DOACs are not available in Iran, and the physicians have to use alternative choices, including PCC and FFP. All of these issues emphasis on a more objective assessment of the current trend towards DOACs as the first-choice of anticoagulant therapy.
Conclusion: It seems that in Iran, similar to most other parts of the world, with the advent of the new anticoagulants, the overall pattern of anticoagulation therapy is shifting toward DOACs. Among, DOACs, rivaroxaban is the most commonly used anticoagulant in Iran. Dabigatran, as a direct thrombin inhibitor (DTI), is another commonly used DOAC.
Keywords: Anticoagulation therapy; thrombosis; direct oral anticoagulants