Hypersensitivity reactions to non-vitamin K oral anticoagulants - a review of literature and diagnostic work-up proposal

¹SOS Allergologia e Immunologia, Azienda USL Toscana Centro, Italy
²UOC Medicina Interna e Reumatologia, Allergologia, Ospedale Infermi, Rimini, Italy

Publication History:
Published online: 12 November 2018
Accepted: 06 November 2018
Received: 17 October 2018

Doi
https://doi.org/10.23822/EurAnnACI.1764-1489.80

Summary
Non-vitamin K antagonist oral anticoagulants (NOACs) are increasingly being used in hospital and outpatient settings as safe alternatives to warfarin. Hypersensitivity reactions have been described for NOACs and can be classified according to Gell and Coombs. We reviewed case reports of possible drug hypersensitivity reactions, noticing a predominance of delayed reactions (both mild and severe) and the absence of cross-reactions to warfarin and low molecular weight heparins. International experience on diagnostic tests is lacking. The vast majority of authors refer to probability scores and rely on biopsy to classify vasculitis and rule out differential diagnoses. We propose to adapt available tests to confirm the patient's reactivity to new anticoagulants. Among in vivo tests, patch testing revealed promising in delayed reactions.

Keywords
novel oral anticoagulants or non-vitamin K oral anticoagulants (NOACs); rivaroxaban; apixaban; edoxaban; dabigatran; hypersensitivity