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Direct oral anticoagulants (DOACs)

Direct oral anticoagulants (DOACs)

anwerghanijaber
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Direct oral anticoagulants (DOACs)

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  1. Direct Oral Anticoagulants (DOACs) Anwer Ghani FIBMS Iraq .

  2. Direct oral anticoagulants (DOACs) have quickly become attractive alternatives to the long‐standing standard of care in anticoagulation, vitamin K antagonist. • Since the first approval in 2010, DOACs have emerged as leading therapeutic alternatives that provide both clinicians and patients with more effective, safe, and convenient treatment options in thromboembolic settings.

  3. Direct oral anticoagulants (DOACs)—dabigatran (Pradaxa), rivaroxaban (Xarelto), apixaban (Eliquis), edoxaban (Savaysa), and betrixaban (Bevyxxa) are anticoagulation pharmacotherapy used for the prevention of thrombosis in several cardiovascular contexts. • DOACs are categorized into 2 main classes: oral direct factor Xa inhibitors (ie, rivaroxaban, apixaban, edoxaban, and betrixaban) and direct thrombin inhibitors (ie, dabigatran).

  4. DOACs are relatively new agents demonstrating superiority or noninferiority to prior standards of care, anticoagulation with vitamin K antagonists (VKA; ie, warfarin), or low‐molecular‐weight heparins (LMWHs), in reducing risk of thromboembolic complications with similar or reduced bleeding risk. • Advantages of DOACs compared with VKAs include fewer monitoring requirements, less frequent follow‐up, more immediate drug onset and offset effects. • DOAC prescriptions exceeded those for warfarin by 2013, with apixaban being the most frequently prescribed DOAC for patients with nonvalvular atrial fibrillation (NVAF).

  5. Dabigatran, rivaroxaban, apixaban, and edoxaban are approved for the lowering the risk of stroke and embolism in NVAF as well as deep vein thrombosis and pulmonary embolism treatment/prophylaxis.

  6. Unique indications include betrixaban for prophylaxis of venous thromboembolism (VTE) in hospitalized patients for an acute medical illness, and rivaroxaban in combination with aspirin to reduce major cardiovascular events in patients with chronic coronary artery disease (CAD) or peripheral artery disease.

  7. AF and PCI • Dual therapy: rivaroxaban (15 mg ) and a P2Y12 inhibitor ( clopidogrel) or • Triple therapy with rivaroxaban 2.5 mg twice daily plus DAPT • lower bleeding risk in comparison to triple therapy (VKA at standard AF dosing, aspirin, and clopidogrel but similar thrombotic events. • Dabigatran (150 mg twice‐daily) same.

  8. AF and Artificial Heart Valves • VKA remains the preferred agent for this patient population . • bioprosthetic: acceptable (need study).

  9. Atrial Fibrillation With Stable Coronary Disease • The rivaroxaban monotherapy arm was noninferior than combination ( DOAC+AP) in cardiovascular efficacy measures and superior in reducing major bleeding. combination

  10. Cancer‐Associated Thromboembolism • DOAC are not inferior than LMWH in treatment and prevention of VTE in cancer patient.

  11. CKD • all are renal excretion. • Apixoban is the least. • Dose reduction if: age>65, wt<60 and scr>1.5.

  12. THANKS • REFERENCE • https://www.ahajournals.org/doi/full/10.1161/JAHA.120.017559

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