Factor Xa Inhibitors (DOACs) Flashcards
Give 4 examples of DOACs
- Apixaban
- Dabigatran
- Edoxaban
- Rivaroxaban
What is the mechanism of action of DOACs?
Directly inhibit factor Xa, thus disrupting the clotting cascade
What is the route of delivery of DOACs?
PO
What are the indications for DOACs?
- Treatment and prophylaxis of DVT and PE in hip and knee replacements
- Stroke prophylaxis in non-valvular AF
What are the contraindications for DOACs?
- Active, clinically significant bleeding
- Antiphospholipid syndrome
- Risk factors for major bleeding
- Haemodynamically unstable patients with PE, or patients who may undergo thrombolysis or pulmonary embolectomy
What are the cautions for DOACs?
- Post-op analgesia with epidural catheter in situ
- Prosthetic heart valves
- Hepatic impairment
- Pregnancy
- Breastfeeding
- Renal impairment
At what creatinine clearance should DOACs be used with caution?
<15ml/min
What might DOACs interact with?
Other anticoagulants (increased risk of bleeding)
What are the common side effects of DOACs?
- Bleeding and bruising
- GI upset, particularly nausea
What are the less common side effects of DOACs?
Hepatobiliary disorders
Is INR monitoring required with DOACs?
No
What monitoring is required with DOACs?
- Check for signs of bleeding or anaemia
- Check eGFR before and after starting treatment
Why do you need to check eGFR with DOACs?
To ensure that baseline renal function is sufficient for drug, and to monitor for future renal impairment
What patient counselling is required with DOACs?
- Compliance
- Concurrent medications
- Excessive bleeding
- Medical alert bracelet
What counselling regarding compliance is required with DOACs?
Emphasise the importance of taking the drug as directed. They should be swallowed whole and taken at the same time each day
