25 - Oral Anticoagulants Flashcards
Rivaroxaban
Xarelto
DOSING:
DVT Following Hip or Knee Replacement Surgery
- *CrCL <30 mL/min**
- *AVOID**
- *10mg QD**
- with or without food*
DABIGATRAN = Pradaxa
- *Treatment / Reduction in risk of DVT & PE**
- *DOSING**
Treatment / Reduction in risk of DVT & PE
CrCl >30:
150mg BID after 5-10 days of Parenteral AC “Bridge”
CrCl < 30 or Dialysis
dosing not provided
CrCl <50 + P-gp Inhibitor
AVOID co-admin
Rivaroxaban
Xarelto
DOSING:
DVT or PE Treatment
15mg wf BID x 21 days
then
20mg wf QD
- *CrCl < 30 ml/min**
- *AVOID**
Which AC drug is
CONTRAINDICATED w/ CrCL > 95?
EDOXABAN = Savaysa
Non-Valvular AFIB w/ CrCL > 95
Is
CONTRAINDICATED
Also CrCl < 15
Which AC drug inhibits
Factor Xa?
Rivaroxaban** / **Apixaban** / **Edoxaban
Xarelto / Eliquis / Savaysa
Betrixaban
Which AC drugs require
BRIDGING / Parenteral Lead-In
DABIGATRAN
DVT/PE Treatment –> 5-10 days of Bridge
then 150mg BID (reg dose)
EDOXABAN
DVT/PE Treatment –> 5-10 days LMWH/UFH
then 30mg QD (normal is 60mg)
Dabigatran
Pradaxa
DRUG INTERACTIONS
- *AVOID with Pg-p INDUCERS**
- *Rifampin / Carbamazepine / Phenytoin**
Pg-P Inhibitors
↑Drug Concentration –> ↑Risk of Bleeding
DRONEDERONE** or **KETOKONAZOLE
AFIB:
CrCl 30-50 = 75mg BID, CrCl <30: Avoid
Ortho VTE Prophylaxis:
CrCl >50 = seperate doses by hours, <50 = AVOID
Apixaban
Eliquis
DOSING:
Reduction in risk of recurrent DVT & PE following initial therapy
- *2.5mg BID**
- same as prophylaxis of DVT following hip/knee replacement*
DABIGATRAN = Pradaxa
- *Reduction in STROKE risk & Systemic Embolism in Non-Vascular AF**
- *DOSING**
Reduction in STROKE risk & Systemic Embolism in Non-Vascular AF
CrCl > 30:
150mg BID
CrCl: 15 - 30
75mg BID
CrCl <15 or Dialysis
no dosing rec
CrCl 30 - 50 + P-gp Inhibitor
if Dronedarone or Ketoconazole –> 75mg BID
CrCl <30 + P-gp Inhibitor
AVOID co-admin
Apixaban
Eliquis
DOSING:
↓Risk of Stroke + PEinNonvalvular AFIB
5mg BID
2.5mg BID –> if 2 of the following:
> 80 y/o
Weight < 60kg
Scr > 1.5mg/dL
Apixaban
Eliquis
DRUG INTERACTIONS
P-gp + Strong CYP3A4 INDUCERS
P-gp + Strong CYP3A4 INDUCERS
RIFAMPIN / Carbamazepine / Phenytoin
BARBITURATES / St. Johns Wort
AVOID WITH APIXABAN
decrease apixaban exposure
same as DABIGATRAN
Which AC drug should you AVOID/CONTRAINDICATED
with
P-gp INDUCERS
Rifampin / Carbamazepine / Phenytoin
St. John’s Wort / Ritonavir / Avasimibe
DABIGATRAN
APIXABAN** + **EDOXABAN
+barbiturates
Edoxaban
Savaysa
Contraindications
P-gp INDUCERS
Rifampin / Carbamazepine / Phenytoin
- *CrCl > 95** for AFIB
- still 60mg qd for VTE/PE treatment*
CrCl < 15
Weight <60 kg
Edoxaban
Savaysa
DOSING:
Non-valvular AFib
- *CrCl 50-95**
- *60mg QD**
- *CrCL 15-50**
- 30mg QD**, no clinical data*
- CrCL > 95* or wt <60kg _or CrCL < 15_
- CONTRAINDICATED*
Apixaban
Eliquis
DOSING:
TREATMENT of DVT + PE
5mg BID
2.5mg BID –> if 2 of the following:
> 80 y/o
Weight < 60kg
Scr > 1.5mg/dL