DOACs

• Apixaban, edoxaban and rivaroxaban MOA:

  • Competitively inhibit both free and clot-bound factor Xa
• Dabigatran MOA:

  • Inactive prodrug
  • reversibly inhibiting free thrombin, fibrin-bound thrombin, and thrombin-induced platelet aggregation.
  • Inhibiting thrombin prevents the conversion of fibrinogen to fibrin
• Baseline assessments should include:

  • Clotting screen
  • Full blood count (FBC)  
  • Liver function tests (LFTs)
  • Urea and electrolytes (U&Es)

  Subsequently, annual monitoring of FBCs, renal and liver function tests is advised.
• contraindications based on renal function:2

  • Dabigatran should be avoided in patients with creatinine clearance (CrCl) under 30
  • Rivaroxaban and apixaban should be avoided in patients with creatinine clearance (CrCl) under 15
• Apixaban has a half life of around 10 hours
• Reversal:

  • Dabigatran - Idarucizumab
  • Apixaban and rivaroxaban - Andexanet alfa (Ondexxya)