Sheikh Abdul Khaliq, Syeda Rashiq ul Ain, Areeba Khan

PERSONALIZED ANTICOAGULANTS: TAILORING THERAPY TO INDIVIDUAL PATIENT'S NEED

Introduction

Personalized anticoagulants: tailoring therapy to individual patient's need. Personalized anticoagulants: Tailor therapy for DVT, MI, stroke & AF to individual patient needs. Maximize efficacy, safety & minimize bleeding risk with DOACs, warfarin & heparin.

Abstract

Background: Thromboembolic diseases lead to deep vein thrombosis, myocardial infarction, pulmonary embolism, atrial fibrillation and stroke. To avoid these complications, Direct oral anticoagulants (DOACs) and parenteral anticoagulants have been options since the discovery of the first oral anticoagulant, i.e., warfarin. Objective: This review explores the role of personalized anticoagulant therapy in optimizing treatment efficacy and safety, with a focus on minimizing bleeding complications through individualized drug selection. Methods: A narrative review of anticoagulant therapies and their effects on patients' safety profiles was conducted on literature published from January 2010 to December 2024. Verified databases were used for the literature collection, followed by the PRISMA method. Quality of literature was evaluated by GRADE (Grading of Recommendation Assessment, Development and Evaluation) criteria. Findings: Findings demonstrated that direct oral anticoagulants (DOACs) are more effective than warfarin in mitigating the risk of stroke associated with venous thromboembolism (VTE) and atrial fibrillation (AF) with less risk of bleeding. However, despite the warfarin risk of bleeding and nephropathy, it remains the standard oral anticoagulant in prosthetic valves or severe mitral stenosis patients. In a patient with renal failure, the choice of drug is heparin. Enoxaparin is recommended in severe renal impairment with dose adjustment. Genomics, age, gender, comorbidities, bleeding risk, and hepatic and renal function should also be considered while choosing DOACs or heparin. Conclusion: Incorporating patient-specific variables into anticoagulant selection is essential for maximizing benefit and minimizing harm, underscoring the shift toward precision medicine in thromboembolic care.

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