DOAC Flashcards
Which anticoagulants are DOACs
Apixaban
Dabigatran
Edoxaban
Rivaroxaban
Betrixaban
By what mechanisms are DOACs eliminated
renally
Which has the shortest half life and achieves steady state quicker
Rivaroxaban
Most have what common side effect
Bleeding
Which has dyspepsia
Dabigatran
Which has the longest half life
Dabigatran
Which achieve steady state 2-3 days
Dabigatran
Apixaban
Edoxaban
Which are used when considering switching from heparin, LMWH and fondaparinux after days of initiation
Dabigatran and Edoxaban
Which should be taking with food if dose is ≥15 mg
Rivaroxaban
Which can be used for treatment of VTE
Apixaban and rivaroxaban
What is the dosing of Dabigatran when used as maintenance
150 mg BID
What’s the dosing of Edoxaban when used as maintenance
60 mg daily
What is the dosing of Apixaban
10 mg BID for the first 7 days
Switch to 5 mg BID
If patient has recurrent VTE and low risk what dose Of Apixaban should be administered
2.5 mg BID
What is the dose of rivaroxaban
15 mg BID for 21 days
Switch to 20 mg daily with food
A patient presents to your clinic and has a BMI >40kg or TBW > 120 kg which DOAC is not appropriate
Dabigatran
Rivaroxaban
Apixaban
Edoxaban
A patient presents to your clinic with a TBW < 60 kg what dose of Edoxaban should be administered
30 mg with food
A patient present at your mini with a CrCl < 30 ml/min what DOAC should be avoided
Dabigatran
Rivaroxaban
Apixaban
Two patient present to your clinic:
Patient A has CrCl between 15-30 ml/min
Patient B has a CrCL less than 15 ml/min
How should both patient be dosed with edoxaban
Patient A: administer 30 mg with food
Patient B: avoid Edoxaban
When considering switching from a warfarin to a DOAC what are the target INR
Dabigatran < 2.0
Rivaroxaban < 3.0
Apixaban < 2.0
Edoxaban <2.5
What should patient do if Dabigatran dose is missed
Take ASAP but 6 hours before the next dose
What should a patient do if 15mg rivaroxaban dose is missed
Take 30 mg dose
What should a patient do if Apixaban and Edoxaban doses are missed
Take ASAP
When switching from DOAC to warfarin what should INR value be
> 2.0
What is the antidote for Dabigatran
Idarucizumab (5 grams IV): 2.5 g infused 15 mins apart
What’s factor Xa antidote (Apixaban and rivaroxaban)
Andexanet alpha
When is bridging considered for VTE patients
When patient is at high risk:
Recurrent VTE < 3 months:
Protein S deficiency Protein C deficiency Homozygous Factor V Leiden or prothrombin gene mutation Antithrombin Ill deficiency Antiphospholipid syndrome
What is perioperative management VKA Anticoagulation
Stop warfarin 5 days prior to surgery
Initiate LMWH for moderate to high risk patient
Stop LMWH 24 hours prior to procedure
Last dose should be half a dose
Restart warfarin 12-24 hours after
Restart LMWH 48-72 hours after
For DOACs timing of last dose prior to surgery is dependent on what factor
Creatinine clearance
Which form of anticoagulant should not be used in bridging
Parenteral but restart 24-72h after surgery depending on bleeding risk
For patient with VTE and liver disease or pregnant what is the preferred anticoagulant
LMWH
For patient with VTE and cancer what is the preferred anticoagulant
LMWH and DOAC
