Newer anticoagulants dosing guide 2014

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To the Editor Dr Powell advocated for individualized therapy for the new direct-acting oral anticoagulants (DOACs) based on defined therapeutic target ranges si. Feb 25, 2015 In the last 5 years, oral anticoagulant therapy is now witnessing a revolution after the completion of large phase III clinical trials on the commonly termed the new oral anticoagulants (NOACs). Advantages of these new agents including the uses of fixed-dosing with no need for monitoring, few interactions, The recent availability of these 3 new oral anticoagulants is challenging for health professionals, as they differ in many ways from warfarin and each other, including in their mechanism of action, pharmacokinetics, drug interaction profile, monitoring and dosage adjustment requirements. Despite their widespread use in the Non-Vitamin K antagonist oral anticoagulants (NOAC) are now widely used in patients with non-valvular atrial fibrillation (AF) and for the treatment and prevention of venous thromboembolism (VTE) in NSW Health facilities. NOACs include dabigatran, (direct thrombin inhibitor), apixaban and rivaroxaban (Factor Xa on Antithrombotic Drug. Dosing and Management of Antithrombotic Drug-. Associated Bleeding. Complications in Adults. February 2014*. Mary Cushman1 . dabigatran. CrCl < 30 ml/min: start 24 hours after last dose of dabigatran. Rivaroxaban. Warfarin. (INR 2-3). -US: Initiate warfarin and a parental anticoagulant. Target Specific Oral Anticoagulants. Dabigatran. (Pradaxa). Rivaroxaban. (Xarelto). Apixaban. (Eliquis). Drug Classification. Selective thrombin inhibitor . effective anticoagulant in the setting of cardioversion with guidelines similar to warfarin. Nonbleeding Side Effects. Dyspepsia (5-10%). None. Advantages. - Fixed dose. Mar 11, 2016 Abstract: The ideal anticoagulant is oral, has a wide therapeutic range, predictable pharmacokinetics and pharmacodynamics, a rapid onset of action, an available antidote, minimal side effects and minimal interactions with other drugs or food. With the development of the novel direct oral anticoagulants Dec 12, 2013 Table 2: The New Oral Anticoagulants in Atrial Fibrillation Once or Twice Daily A once daily regimen of rivaroxaban was compared with a twice daily regimen in VTE treatment8 (Table 2): here, the dose of 40 mg once daily does not expose patients to a greater risk of bleeding or thrombus growth than 20 mg May 8, 2014 ACP.5.8.2014. WHY NEWER ANTICOAGULANTS? • Therapeutically, unfractionated heparin is optimally used as an IV infusion and needs dosage adjustment: SC administration requires BID or TID dosing. This is awkward. – HIT is becoming an unacceptable adverse event. • Warfarin has a poor Warfarin. For initial warfarin dosing refer to Warfarin. Initiation Protocol. LMWH. Rivaroxaban. (Formulary 1st choice. NOAC). Apixaban. Dabigatran. Warfarin For advice during invasive procedures, refer to Newer anticoagulants and elective procedures guideline. Commence warfarin in combination with rivaroxaban.