About Careers Internship MedBlog Contact us
Medindia LOGIN REGISTER
Direct Oral Anticoagulants (DOAC) in Atrial Fibrillation
Advertisement

Direct Oral Anticoagulants (DOAC) in Atrial Fibrillation

Font : A-A+

Highlights:
  • The new direct oral anticoagulants (DOACs) have been approved for the treatment of non-valvular atrial fibrillation
  • DOACs do not require regular monitoring with INR unlike warfarin
  • DOACs dose should be reduced in kidney dysfunction

Newer drugs called direct oral anticoagulants which include edoxaban, apixaban, rivaroxaban and dabigatran have been approved by the US Food and Drug Administration (USFDA) for the treatment of non-valvular atrial fibrillation. A review on the use of the drugs for the purpose was published in the US Pharmacist.

Atrial fibrillation is a condition where the upper chambers of the heart flutter at a very fast pace. It results in stagnation of blood and formation of clots in the heart. A clot within the circulation can travel to different parts of the body and obstruct the blood supply to that part. This could have serious consequences including a stroke.

Advertisement


Therefore, along with the other medications that are used for atrial fibrillation, anticoagulants form an important part of the treatment of atrial fibrillation.

Warfarin has been the only oral anticoagulant available for a very long time.
  • It requires frequent monitoring of its effect through the measurement of the International Normalized Ratio (INR)
  • It interacts with other medications
  • It can cause fetal malformation when used in pregnancy
Newer oral anticoagulants have been approved by the USFDA for the treatment of non-valvular atrial fibrillation, that is, atrial fibrillation that occurs in the absence of heart valve disease. The heart valves allow the passage of blood through the chambers of the heart in a single direction.
Advertisement

The DOACs can be used in those patients in whom the INR cannot be maintained within the desired range. They do not require monitoring of INR and can be administered as a fixed dose. However, kidney function should be regularly monitored in patients taking these medications. It is also important to note that specific antagonists to these drugs are not yet available. Prothrombin complex concentrate has sometimes been used to reverse the anticoagulation caused by the medications. Idarucizumab has recently been approved for the treatment of serious bleeding following the use of dabigatran.

A summary of the important information derived from the article published in the US Pharmacist by Hoie EB and colleagues is presented below:

Edoxaban

  • Edoxaban is available as a tablet to be taken in a dosage of 60 mg per day for a patient with non-valvular atrial fibrillation
  • Since most of it is excreted from the body through the urine, the dosage has to be reduced in those with reduced kidney function. It should not be used by patients with severe kidney disease and mild-to-moderate liver disease. It belongs to pregnancy Category C and should not be used during breastfeeding
  • The use of drugs like rifampin, other anticoagulants and antiplatelet drugs which could alter the effect of edoxaban should be avoided in a patient taking edoxaban
  • As expected, side effects are bleeding and anemia

Apixaban

  • Apixaban is used in a dosage of 5 mg twice a day. The dosage should be reduced in individuals with severe kidney disease, over 80 years of age, and in patients with body weight of less than 60 kg
  • It can be used during pregnancy (Pregnancy category B), but can increase the risk of bleeding. It should not be used by nursing mothers or those with severe liver disease
  • It should not be used with drugs that may alter its metabolism or its blood levels

Rivaroxaban

  • Rivaroxaban is used in a dose of 20 mg a day with the evening meal. Dosage should be reduced in patients with kidney disease, and should be avoided in patient with severe kidney disease.
  • It belongs to Pregnancy Category C and should not be used in nursing mothers
  • It should not be used in patients with moderate-to-severe liver disease
  • It should not be used with drugs that may alter its metabolism or its blood levels

Dabigatran

  • Dabigatran is used in a dose of 150 mg twice daily, which should be reduced in patients with kidney disease
  • It belongs to Pregnancy Category C and should not be used by nursing women
  • It commonly causes gastritis-like adverse events
While dispensing the medication, the pharmacist should also advise and educate the patient on the necessity in taking the medication regularly, to inform the physician in case any other medications need to be taken and the symptoms of side effects, which may appear during the treatment.

Reference :
  1. Hoie EB, O'Brien KK, Neighbors K, Castillo SL, Begley KJ. Direct Oral Anticoagulants for the Prevention of Stroke in Nonvalvular Atrial Fibrillation. US Pharm. (2017);42(2):32-35.


Source: Medindia

Citations   close

Please use one of the following formats to cite this article in your essay, paper or report:

  • APA

    Dr. Simi Paknikar. (2017, February 27). Direct Oral Anticoagulants (DOAC) in Atrial Fibrillation. Medindia. Retrieved on Sep 26, 2022 from https://www.medindia.net/news/healthinfocus/direct-oral-anticoagulants-doac-in-atrial-fibrillation-168171-1.htm.

  • MLA

    Dr. Simi Paknikar. "Direct Oral Anticoagulants (DOAC) in Atrial Fibrillation". Medindia. Sep 26, 2022. <https://www.medindia.net/news/healthinfocus/direct-oral-anticoagulants-doac-in-atrial-fibrillation-168171-1.htm>.

  • Chicago

    Dr. Simi Paknikar. "Direct Oral Anticoagulants (DOAC) in Atrial Fibrillation". Medindia. https://www.medindia.net/news/healthinfocus/direct-oral-anticoagulants-doac-in-atrial-fibrillation-168171-1.htm. (accessed Sep 26, 2022).

  • Harvard

    Dr. Simi Paknikar. 2021. Direct Oral Anticoagulants (DOAC) in Atrial Fibrillation. Medindia, viewed Sep 26, 2022, https://www.medindia.net/news/healthinfocus/direct-oral-anticoagulants-doac-in-atrial-fibrillation-168171-1.htm.

Advertisement

Advertisement
News A-Z
A B C D E F G H I J K L M N O P Q R S T U V W X Y Z
What's New on Medindia
H1N1 Influenza Prevention in Children: What Parents Need to Know
Dietary Factors Responsible for Dihydrotestosterone (DHT) Production and Hair Loss
Test Your Knowledge About Chromosomes?
View all
Recommended Reading
News Archive
Date
Category
Advertisement
News Category

Medindia Newsletters Subscribe to our Free Newsletters!
Terms & Conditions and Privacy Policy.

More News on:
Palpitations And Arrhythmias Anticoagulants Pulmonary Embolism Dental Check-Up Atrial Fibrillation Cardiac Ablation Common Side Effects of Anticoagulants / Blood Thinners Drugs for Atrial Fibrillation 

Most Popular on Medindia

Sanatogen Turmeric Powder - Health Benefits, Uses & Side Effects Drug Side Effects Calculator Iron Intake Calculator A-Z Drug Brands in India Daily Calorie Requirements Drug - Food Interactions Sinopril (2mg) (Lacidipine) Calculate Ideal Weight for Infants Blood Donation - Recipients
This site uses cookies to deliver our services. By using our site, you acknowledge that you have read and understand our Cookie Policy, Privacy Policy, and our Terms of Use
×

Direct Oral Anticoagulants (DOAC) in Atrial Fibrillation Personalised Printable Document (PDF)

Please complete this form and we'll send you a personalised information that is requested

You may use this for your own reference or forward it to your friends.

Please use the information prudently. If you are not a medical doctor please remember to consult your healthcare provider as this information is not a substitute for professional advice.

Name *

Email Address *

Country *

Areas of Interests