DOACs

Question 1

What characteristics do you need to have to have a DOAC prescribed for stroke prophylaxis?

Answer 1

CHADSVASC- women= 2, men= 1

Congestive heart failure
Hypertension
Age 75+
Diabetes
Stroke/TIA/Thromboembolism
Vascular disease (PAD/prev MI/Aortic plaque)
Age below 75
Sex (women 2)

Question 2

Factors which require a dose reduction

Answer 2

AGE- 75- 80
Body weight- below 60kg
CrCl= 15-50mmol/L
Drugs- interacting = verapamil, amiodarone, erythromycin and ciclosporin

Question 3

Which doacs are given OD

Answer 3

Rivaroxaban
Edoxaban

Question 4

Which doacs are given BD

Answer 4

Apixaban
Dabigatran

Question 5

DOAC indications

Answer 5

Stroke prophylaxis and treatment
VTE prophylaxis and treatment
Rivaroxaban- ACS

Question 6

DOAC monitoring

Answer 6

Renal function
Weight
Bleeding/Bruising

Question 7

MOA of DOACS

Answer 7

Riv and Apix= Direct inhibitor of factor Xa
Edox= Direct and reversible inhibitor of factor Xa
Dab= Direct thrombin inhibitor

Question 8

What strengths of Rivaroxban needs to be taken with food

Answer 8

15-20mg

Question 9

Dose of Apixaban for stroke prophylaxis

Answer 9

5mg BD

Question 10

When is a dose reduction needed for apixaban? and what is the dose?

Answer 10

Age- above 80
Body weight- under 60
Creatinine= 133micromol/L
CrCl= 15-29ml/min

Dose= 2.5mg BD

Question 11

Apixaban- VTE prophylaxis dose

Answer 11

2.5mg BD
Knee = 10-14 days
Hip= 32-38 days

Question 12

Apixaban- VTE treatment dose

Answer 12

10mg BD for 7 days, then maintenance 5mg BD

Question 13

Rivaroxaban- VTE prophylaxis dose

Answer 13

10mg OD
knee= 2 weeks
hip= 5 weeks

Question 14

Rivaroxaban- VTE treatment dose

Answer 14

15mg BD for 21 days then 20mg OD

Question 15

Rivaroxaban- Stroke prophylaxis dose

Answer 15

20mg OD

Question 16

Rivaroxaban- atherothrombotic events following ACS dose

Answer 16

2.5mg for 12 months

Question 17

Edoxaban - prophylaxis stroke/VTE , Treatment DVT, recurrent DVT

Answer 17

Above 61kg= 60mg OD
Below 61kg= 30mg OD

Question 18

Dabigatran- prophylaxis of VTE knee replacement

Answer 18

18-74 yo= 110mg 1-4 hours after surgery then 220mg for 10days

75+ =75mg 1-4 hours after surgery then 110mg for 10days

Question 19

Dabigatran- Treatment VTE, Prophylaxis of recurrent DVT

Answer 19

18-74 yo= 150mg BD for at least 5 days

75-79 = 110- 150mg BD

80+= 110mg BD

Question 20

Dabigatran- stroke prophylaxis

Answer 20

Age 18-74= 150mg BD
Age 75-79= 110mg- 150mg BD
Age 80+= 110mg BD

Question 21

Edoxaban interactions- requiring dose reduction

Answer 21

Erythromycin, ciclosporin, ketoconazole, dronedarone

Question 22

Dabigatran interactions- requiring dose reduction

Answer 22

Verapamil and amiodarone

Question 23

Rivaroxaban and Apixaban antidote

Answer 23

Andexanet Alpha (ONDEXXYA)

Question 24

Edoxaban antidote

Answer 24

there’s not one

Question 25

Dabigatran antidote

Answer 25

Idarucizumab (praxbind)

Question 26

What should all DOACS come with

Answer 26

warning card (Label 10)

Question 27

Dabigatran cautionary labels

Answer 27

warning card
Swallow whole/don’t crush or chew- label 25

Question 28

Rivaraoxban cautionary labels

Answer 28

warning card
take with or just after food - label 21