DOAC Flashcards
What is the dose of dabigatran FOR AF if aged under 80 years old?
150mg bd
What is the dose of dabigatran FOR AF if aged over 80 years old/taking verapmail?
110mg bd
What is the dose of dabigatran following a DVT/PE
Following parenteral anticoagulant for at least 5 days, 150mv bd
When should a dose of 110mg bd for dabigatran be considered?
If bleeding risk high: 75-80 years, gord, oesaphagitis, gastritis, crcl 30-50ml/min
When is dabigatran contraindicated
Hypersensitivity, significant risk factor for bleeding, active bleeding, in combination with anticoauglant, concomitant treatment with ketoconazole, itraconazole, cyclosporin, dronedarone, prosthetic heart valves
How should dabigatran be administered?
With/after food. swallwowed who, do not open capsules
Can dabigatran go into a compliance aid?
No
How long after a missed dose can dabigatran be taken?
Missed dose may be taken up to 6 hours
prior to next scheduled dose
What must be monitored with regards to renal function and dabigatran?
Baseline renal function before initiation.
Contraindicated in CrCl<30ml/min
Is dabigatran indicated in hepatic impairment?
Not recommended in patietns with elevated
liver enzymes >2xULN
CI in patients with hepatic impairment or
liver disease expected to impact on survival
What is the antidote for dabigatran
Idarucizumab
What is the dose of rivaroxiban for AF
20mg OD
CrCl 15-
59ml/min 15mg
What is the dose of rivaroxiban for DVT/PE
15mg BD for 21
days, then 20mg
daily (minimum
3 months)
CrCl 15-
49ml/min 15mg
BD for 21days
then 20mg OD or
15mg OD if risk
of bleeding > risk
of recurrent DVT
What is the dose of rivaroxiban for ACS
2.5mg BD with
aspirin alone
OR
Aspirin + clopidogrel
Use with caution if
>75 years or if <60kg
What are the contraindications for rivaroxiban?
Hypersensitivity
Significant risk factor for major bleeding
Active bleeding
In combination with an anticoagulant (except when
switching)
Pregnancy & breastfeeding
Concomitant treatment of ACS with antiplatelet therapy in patients with prior stroke or tia
Should rivaroxiban be taken with food
15mg and 20mg dose must be taken with food to increase
absorption. May be crushed if required (off license)
Can rivaroxiban be used in compliance aids?
Yes
What should happen in the case of a missed rivaroxiban dose?
OD dosing: Missed dose should be taken immediately and
then continued on the following day.
Do not double a dose within the same day to make up for
a missed dose (except if taking 15mg BD for DVT/VTE
treatment, take 2x15mg immediately to ensure a dose of
30mg daily. Continue 15mg BD intake the following day
What is the monitoring requirements for rivaroxiban?
Baseline renal function before initiation.
Not recommended if CrCl<15ml/min
Use with caution if CrCl 15-29ml/min
Can rivaroxiban be give in hepatic impairment
Use with caution as requires hepatic metabolism.
CI hepatic disease associated with coagulaopathy &
clinically relevant bleeding risk.
What is the antidote for rivaroxaban
No antidote
What us the dose of apixaban for af
5mg BD
2.5mg BD if CrCl 15-
29ml/min
2.5mg BD if 2+ of the
following:
Age ≥ 80 yrs
Weight ≤ 60kg
Serum Cr ≥
133μmol/
What is the dose of apixaban for dvt/pe
Treatment PE/DVT 10mg
BD for 7 days then 5mg
BD
Prevention DVT/PE after
6months treatment dose
2.5mg BD
Individualised treatment
duration
What are the contrainidcations for apixaban
Hypersensitivity
If a significant risk factor for major bleeding
Active clinically significant bleeding
In combination with an anticoagulant (except
when switching
