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NOACs and DOACs - Coggle Diagram

- - - - Apixaban (Eliquis)
        
        Onset 3-4 hrs
        
        Half life 12 hrs
        
        Not recommended in pts undergoing dialysis
        
        Dose in NVAF (Nonvalvular atrial fibrillation) 5 mg BD
        
        NVAF adjustments
        
        Age >80 yrs
        
        Renal function (serum creatintin >=133 μmol / L)
        
        Weight <60kg
      - Edoxaban (Lixiana)
        
        Onset 1-3 hours
        
        Half life 10-14 hours
        
        Dosing
        
        Standard dose in NVAF 6mg OD
        
        Renal function
        Not recommended for reduced CrCl <15ml/min or dialysis and increased CrCl >95ml/min
        
        Body weight <=60kg
        
        3 Interactions
        Ciclosporin
        Dronedarone
        Erythromycin
        Ketoconazole
        
        Not licensed for VTE prophylaxis
      - Rivaroxaban (Xarelto)
        
        Onset 2-4 hours
        
        Half life 5-9 hours
        
        Dose
        
        Standard dose NVAF 20mg OD
        
        Adjust
        
        Renal function
        Not recommended if CrCl <15ml/min
        
        Interactions
        P-gp and stong CYP 3A4 inhibitors
        Rionavir
        Iopinavir
        Ketoconazole
        Itraconazole
        
        Efficacy unaffected by weight
        
        Bioavailability increases with food ( 20mg and 15 mg - take with food)
    - - Dabigatran (Pradaxa)
        
        Onset immediate - Peak at 2-3 hours
        
        Half life 12-14 hours
        
        Dosing
        
        Standard in NVAF 150mg BD
        
        Adjust for
        
        Age
        Over 80 yrs
        Over 75 yrs and reduced renal function / GORD/ high bleeding risk
        
        Renal Function
        Contraindication CrCl >30ml/min
        
        GORD (Gastroesophageal reflux disease)
        
        Interactions
        Verapamil
        
        Reversal agent
        
        Idarucizumab approved
        Monoclonal antibody binds dabigatran with 350x affinity as thrombin
        Binds free and thrombin bound dabigatran
        5mg IV
        Reversal in minutes
  - - - VTE prevention following elective TKR or THR surgery
    - - Stroke Prevention in NVAF
        Treatment of DVT and PE
        Prevention of DVT and PE
    - - Prevention of atherothrombotic events in pateints with CAD or PAD ( in combination with aspirin
  - - - DOAC choice
      - Dose
      - Contraindication
      - Considerations (age, weight, renal function)
      - Counselling patient
        New pts
        Missed doses
        Swithing DOACs / from warfarin
      - Indication
    - - High bleeding risk
      - Renal impairment
      - Gastro issues
      - Previous stroke
      - Pt preference
    - - Correct DOAC
        
        Correct Dose
        
        Correct Frequency
      - Discharge prescription should clearly state DURATION OF TREATMENT
        If Apixaban - how many further days of 10mg BD before reducing to 5mg BD
  - - - DOAC-PgP interactions
        
        Increased DOAC absorbed
        
        Increased risk of bleeding
        
        P-glycoprotein transporter in intestinal mucosal cells regulates drug uptake
        
        Verapamil inhibits PgP
      - CYP3A4
        
        Metabolises Apixaban and Rivaroxaban
        
        Enzyme inducers reduce DOAC plasma conc
        Increased risk of thromboembolic events
        
        Enzyme inhibitors increases DOAC plasma conc
        Increased risk of bleeding
    - - Oher anticoagulants
      - Antiplatelets
      - NSAIDs
      - HAS-BLED >= 3 (AF patients)