Filipe Gonçalves: Are DOACs Truly Pharmacokinetically Predictable or Simply Pharmacodynamically Forgiving?
Filipe Gonçalves, Docente at NOVA Medical School, shared a post on LinkedIn about a recent article by Joseph R. Shaw and Jack Ansell, published in Journal of Thrombosis and Haemostasis (JTH), adding:
”Are DOACs truly pharmacokinetically predictable or simply pharmacodynamically forgiving?
This article challenges a central assumption behind fixed-dose DOAC therapy.
Drug concentrations may vary considerably, while clinical effectiveness may persist because the pharmacodynamic response remains acceptable across a relatively broad exposure range.
It also highlights an important distinction between measuring drug concentration and measuring anticoagulant effect.
It also reminds us that commonly used thresholds such as 30 or 50 ng/mL are pragmatic decision cut-offs, not biologically validated safety boundaries.
A relevant perspective for pharmacology, laboratory medicine and urgent clinical decision-making.”
Title: A light in the dark—reframing direct oral anticoagulant pharmacokinetics and pharmacodynamics for near-patient decision-making
Authors: Joseph R. Shaw, Jack Ansell
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