Direct oral acting Anticoagulants (DOACs) Flashcards
Exam areas
Indications
Monitoring
Cautions
Counselling/Cautionary labels
VTE Prophylaxis/Treatment
Doses for stroke/AF & Risk factors
MOA
Reversal agents
General points
DOACs preferred in NON valvular AF (AF not caused by heart valves but other issues). Warfarin preferred in valvular AF.
DOAC for stroke prophylaxis needs to align with CHADVASc score.
ABCD require dose reduction:
A- Age =/>80
B- Body weight <61/60Kg
C - CrCl (15-50)
D - Drugs (Verapamil, Amiodarone, Erythromycin, Ciclosporin)
Rivaroxaban ONLY 1 used in ACS (2.5mg BD) (exception to below)
Generally - RE (OD) AD(BD)
R - VTE prophylaxis 10mg OD, Stroke 20mg OD
A - VTE prophylaxis 2.5mg BD, Stroke 5mg BD
{R is double A)
Monitor kidneys
ALL contraindicated in antiphospholipid syndrome [immune response that makes antibodies which make blood clots]
FOR DOSES LOOK AT PHONE PIC
DOACs more info
READ- Rivaroxaban, edoxaban, apixaban, dabigatran
Less bleeding than warfarin and dont need monitoring as much.
ALL Pts have alert cards (EXAM Q) - Label 10
Inhibit thrombin or Factor Xa. (Xa in name = Xa inhibitor)
Antidotes (EXAM Q)
ALL have 1 EXCEPT Edoxaban
{Others have I in their name = Antidote}
Rivaroxaban, Apixaban, fondaparinux Antidote:
- Andexanet alfa (ondexxya)
Dabigatran Antidote:
- Idarucizumab (Praxbind)
Heparin Antidote:
- Protamine
Warfarin Antidote:
- Vit K/Phytomenadione
Indications of DOACs (EXAM Q)
Prophylaxis of stroke and systemic embolism in NON VALVULAR AF. {PT has to have AF for DOAC use in stroke}
Secondary prevention VTE and VTE prevention in elective hip/knee surgery
Treatment of VTE
R - for prevention of atherothrombotic events inc. ACS
Monitoring
Routine not needed
Effects last 12-24 hr (OD-BD)
RE-24 hrs, AD-12 hrs
Monitor for signs of bleeding and anaemia.
Rivaroxaban
Indications
Prophylaxis of stroke and systemic embolism in non valvular AF, VTE treatment and recurrent VTE prophylaxis = Higher doses (15/20mg)
VTE prophylaxis- 10mg OD
Prophylaxis of stroke and systemic embolism in non valvular AF with 1 of congestive HF, HTN, previous stroke or TIA, age ≥ 75 years, or diabetes = 20mg OD (Have to have 1 of)
MHRA warning (EXAMQ)
15mg and 20mg NEED to be taken with FOOD.
- Can affect stomach so food reduces that chance of Gi effects.
Apixaban
Prophylaxis of stroke and systemic embolism in non valvular AF
Adult dose 5mg BD reduce to 2.5mg BD in PTs with 2 of:
(ABCC)
Age =/>80
Body weight =/< 60kg
Creatine =/>133micromol/L
CrCl = 15-29ml/min
VTE Treatment/Prophylaxis. Hip/Knee prophylaxis
High dose 10mg BD = VTE treatment
- Maintenance = 5mg BD
Prophylaxis doses are lower
- 2.5mg BD
Edoxaban
Indications
Prophylaxis of stroke and systemic embolism in non valvular AF with 1 of congestive HF, HTN, previous stroke or TIA, age ≥ 75 years, or diabetes
VTE Treatment
DOSE is 30mg OD if <61kg
60mg OD if >61kg
Dabigatran
Main doses:
Prophylaxis of VTE in Hip/Knee replacement:
18-74 yrs
110mg OD 1-4 hrs after surgery THEN 220mg OD 10 days
75+/using amiodarone or verapamil: 75mg then 150mg 10 days
Treatment of VTE/Prophylaxis of recurrent VTE: [ALL at least 5 days)
18-74: 150mg BD
75-79: 110-150mg BD
80+: 110mg BD
Stroke prophylaxis 110-150mg BD.
Cautionary labels (EXAM Q)
Rivaroxaban
Label 21 (15mg, 20mg) - Take with or just after food
Brand name Xarelto (2.5mg, 5mg, 10mg, 15mg, 20mg)
Edoxaban
Label 10 - “Warning: Read additional info with this med”
Brand name Lixiana (30mg, 60mg)
Apixaban
Label 10 - (above)
Brand name Eliquis (2.5mg, 5mg)
Dabigatran
Label 10 (above), Label 25 - Swallow this medicine whole Don’t crush or chew
Brand name Pradaxa caps (75mg, 110mg, 150mg)
Important safety INFO (EXAM Q)
Contraindications
Switching from warfarin to Rivaroxaban - STOP warfarin 1st
NO 2 DOACs at the same time.
Conditions with sig. bleeding risk.
Antiphospholipid syndrome
