Direct-Acting Oral Anticoagulants- Pharmacy Technician
Price
Credits
Format
This issue will review the evidence supporting DOACs and
their place in therapy for: 1) atrial fibrillation (AF); 2) the acute
treatment and long-term secondary prevention of deep vein
thrombosis (DVT) and pulmonary embolism (PE); and 3) DVT
and PE prevention after major orthopedic surgery and in medically
ill patients. The differences among DOACs will be highlighted
(eg, side effect profiles, dosing considerations and drug interactions),
and DOACs will be compared with warfarin for conditions
where both are indicated. Bleeding management and the use of
reversal agents will also be addressed.
For more than 50 years, vitamin K antagonists (VKAs) such
as warfarin were the only oral anticoagulant options for patients
with blood clotting disorders. In 2010, dabigatran (Pradaxa®)
- a direct thrombin inhibitor - became the first approved agent
from the next generation of oral anticoagulants. Over the next 7
years, 4 factor Xa inhibitor oral anticoagulants were FDA approved.
These include rivaroxaban (Xarelto®), apixaban (Eliquis®),
edoxaban (Savaysa™), and most recently, betrixaban (Bevyxxa®).
Early on, this generation of oral anticoagulants was referred to
as NOACs (Novel Oral AntiCoagulants). However, the Institute
For Safe Medication Practices (ISMP) issued a safety alert because
“NoAC” was interpreted as “no anticoagulation” in a patient at
high risk of stroke. The ISMP designated “NoAC” a potentially
dangerous abbreviation and discourages its use. Today, the acronym
DOAC, for Direct-acting Oral AntiCoagulant, is the abbreviation
most widely used to distinguish these medications from
warfarin.