Direct-Acting Oral Anticoagulants- Pharmacist

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For more than 50 years, vitamin K antagonists such as warfarin were the only oral anticoagulation option for patients with blood clotting disorders. Dabigatran (Pradaxa®), an oral direct thrombin (factor IIa) inhibitor, finally broke onto the scene with FDA approval in October 2010 as the first of the next generation of oral anticoagulants.Since that time, 3 additional oral anticoagulants have been approved in the US. Rivaroxaban (Xarelto®), apixaban (Eliquis®), and the very recently approved edoxaban (SavaysaTM) are oral direct factor Xa inhibitors that share the convenient attributes of dabigatran: fixed dosing, no routine coagulation monitoring (eg, INR testing), and no known dietary interactions – to name just a few. This issue will review the evidence supporting these next generation oral anticoagulants and their place in therapy for atrial fibrillation (AF), acute treatment and long-term secondary prevention of deep vein thrombosis (DVT) and pulmonary embolism (PE), and DVT and PE prophylaxis after major orthopedic surgery. The differences between the agents will be highlighted,as well as comparisons with warfarin for conditions where both are indicated. Educational and counseling tips for pharmacists and other community-based providers will be presented. Finally, limitations and challenges to the use of the next generation oral anticoagulants will be discussed. Before we begin, here’s a word on nomenclature. Early on, this next generation of oral anticoagulants was convincingly called NOACs (Novel Oral AntiCoagulants), but these drugs would not be novel forever. An Institute For Safe Medication Practices (ISMP) safety alert noted that “NoAC” was interpreted as “no anticoagulation” in a patient at high risk of stroke. The ISMP has designated “NoAC” a potentially dangerous abbreviation and discourages its use. The acronym DOAC for Direct-Acting Oral Anticoagulant provides a reasonably short, easily pronounced, accurately descriptive abbreviation that distinguishes the class from warfarin, which acts indirectly. Wewill use the term DOAC throughout this issue; but be aware that other acronyms (eg, TSOAC [target-specific oral anticoagulant]) are also found in the literature and may work their way into clinical practice.

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Course Information

Target Audience

Pharm/Nurse Drug Therapy

Knowledge Level

General Overview

This activity will apply to a broad range of learning needs/pharmacy settings. It may include common disease state/therapy overivews and/or general pharmacy needs such as medication errors, immunizations, or law topics.

Learning Objectives

Course Accreditation

  • Activity Type:
    Knowledge
  • CE Broker
  • Universal Activity Number:
    Pharmacist : 0428-0000-15-002-H01-P
PharmCon is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education.

PharmCon, Inc. is an approved course provider for continuing education for nurses by the Florida Board of Nursing. PharmCon is also recognized by the California Board of Nursing as a provider of nursing programs.

In order to obtain a Statement of Credit, attendees must answer poll questions where presented and complete a program evaluation. Attendees may immediately print their Statement of Credit or leave them stored on the website.

Technology Requirements

  • Hardware Requirements
    Standard Windows/Mac System
    iPad or iPhone
    Minimum screen resolution: 1024x768
    Speakers or headphones
  • Software Requirements
    Standard Windows/Mac System
    iPad or iPhone
    Minimum screen resolution: 1024x768
    Speakers or headphones
  • Network Requirements
    Broadband Internet Connection:
    T1, Hi-speed DSL or Cable
    4G cellular connection
Computer sharing is NOT permitted due to accreditation guidelines on activity monitoring. Credit is earned by one user per device.