Each week we will aim to bring out a concise email that provides 4-5 key pieces of information addressing a specific issue in clinical therapeutics.
This week: Direct/Newer Anticoagulants Part 1
Saly Rashed, Clinical Pharmacist, Ward MM
Anticoagulants prevent the formation of blood clots and are used for the treatment or prevention of DVT, PE, ischaemic stroke due to AF, acute coronary syndromes and other thrombotic events.
- Blood clots are made up of platelets, fibrin, red blood cells and white blood cells.
- Unlike warfarin, there is currently no reliable blood test for DOACs that can guide their dose adjustment. The correct dose for each DOAC is individually determined based on indication, patient’s weight, age and creatinine clearance.
- DOACs available in Australia are:
- Direct thrombin inhibitor: Dabigatran 75mg, 110mg, 150mg – oral
- Factor Xa inhibitor: Apixaban 2.5mg, 5mg – oral
- Factor Xa inhibitor: Rivaroxaban 10mg, 15mg, 20mg – oral
- There is only one clinical context for administering two anticoagulants simultaneously which is during bridging for therapeutic anticoagulation for a thrombotic event treated with warfarin.
- Enoxaparin is commonly used for bridging anticoagulation until INR is within the therapeutic range. DOACs have very similar onset of action as enoxaparin and therefore do not require bridging anticoagulation.
Please consider these issues when preparing or interpreting RMMR reports or education sessions. Contributions of content or suggested topics are welcome and should be sent directly to firstname.lastname@example.org.