DOACS

Question 1

What’s a DOAC

Answer 1

Direct,oral anticoagulant

Question 2

What’s READ

Answer 2

Rivaroxaban
Edoxaban
Apixaban
Dabigatran

Question 3

When are DOACS preferred?

Answer 3

Preferred in non valvular AF( AF that is not cause by valves but cause by other factors eg.hypertension, an overdose, thyroid gland)

Warfarin is preferred in Valvular AF

Question 4

When do we use DOACS for prophylaxis?

Answer 4

Stroke!

But patients need at least one of the following = Diabetes, hypertension, previous stroke or tIA and their age must be above 75 y/o

ChadsVasc will be used to assess this

Question 5

ABCD for DOAC dose reduction

Answer 5

Age>= 80 y/o
Body Weight over 60kg
Crcl (15-50) - we don’t give for less than 15!!!!
Drugs (Verapamil,Amiodarone,erythromycin and ciclosporin)

Question 6

What is used in ACS with aspirin or clopidogrel? And what is the dose?

Answer 6

RIVAROXABAN (2.5 mg BD) - this is the only BD others are just OD

Question 7

Rivaroxaban and Edoxaban doses are usually how often?

Answer 7

Once daily

Question 8

Apixaban and Dabigatran doses are how often?

Answer 8

Twice a day

Question 9

Rivaroxaban dose for VTE prophylaxis is what?

Answer 9

10mg Once daily

Question 10

Rivaroxaban dose for stroke?

Answer 10

20mg OD

Question 11

Apixaban dose for VTE prophylaxis?

Answer 11

2.5 mg BD

Question 12

Apixaban for stroke dose?

Answer 12

5mg BD

Question 13

What do we need to monitor

Answer 13

Kidneys

Question 14

All DOACS are contraindicated in who?

Answer 14

Antiphospholipid syndrome - its an immune response which created antibodies which makes blood clot, increases the risk of thrombotic events

Question 15

Why are DOACS so loved now?

Answer 15

There’s less bleeding
No monitoring is required compared to warfarin

Question 16

Which cautionary label do doacs have?

Answer 16

Label 10

Question 17

How do they work?

Answer 17

They inhibit thrombin or factor XA

Question 18

Which ones inhibit XA and which ones inhibit thrombin

Answer 18

Apixaban, Edoxaban,Rivaroxaban = XA
Dabigatran = Thrombin = this has a rapid onset of action

Question 19

DOAC indications

Answer 19

• prophylaxis of stroke and systemic embolism in patients with non valvular AF
• Secondary prevention and treatment of DVT or PE
  -Prevention of VTE after elective surgery (hit or knee replacement)
• Rivaroxaban - used to prevent anthrothrombic events including ACS

Question 20

What’s the MHRA warning with Rivaroxaban?

Answer 20

Xarelto is the brand = Label 21 (15mg and 20mg) = higher strengths must be taken with food

Question 21

Not ABCD but ABCC for Apixaban dose reduction when and for what

Answer 21

Adult dose = 5mg twice daily, reduced to 2.5 mg twice daily in patients that are ( AGE= over 80, Bodyweight= 60kg+, Creatnine over 133, CRCL= 15-29

Question 22

Warfarin Fact file and doses =

Answer 22

Initial = 5-10mg day 1 (adjusted according to the patients INR)
Maintenance = 3-9mg (same time each day)

Question 23

Rivaroxaban

Answer 23

• prophylaxis VTE for knee surgery= 10mg OD for 2 weeks
• prophylaxis for hip surgery = 10mg OD for 5 weeks
  -Treatment of VTE of pulmonary embolism = initial 15mg BD for 21 days, maintenance of 20mg OD
• prophylaxis recurrent DVT or PE= 10mg OD or 20mg in high risk patients
• prophylaxis stroke/AF with one risk factor (CHADSVASC) = 20mg OD
• Prolphylaxis of artherthrombic events following ACS = 2.5mg BD for 12 months

Question 24

Apixaban

Answer 24

Prophylaxis VTE for knee replacement = 2.5 mg BD for 10-14 days
Prophylaxis VTE for hip replacement = 10-14 days
(2.5 mg BD for 32-38 days)
Treatment of DVT,PE = 10mg OD for 7 days, maintenance 5mg OD
Prophylaxis recurrent PE,DVT:2.5 mg BD
Prophylaxis of stroke/AF with at least 1 of the risk factors = 5mg and we reduce the dose to 2.5mg BD in patients with at least 2 or the risk factors

Question 25

Edoxaban

Answer 25

Prophylaxis of stroke/AF with at least 1 risk factors = treatment of DVT,Prophylaxis of recurrent DVT, treatment of PE, prophylaxis of recurrent PE Adults weighing 61kg or less - 30mg OD Adults weighing more than 61kg - 60mg OD The duration of treatment is all according to risk factors

Question 26

Dabigatran Doses

Answer 26

Adults(18-74 y/o) - prophylaxis of VTE for knee replacement 110mg for (1-4 hours) after surgery, then 220mg OD for 10 days Adults (75 years +)- 75mg for (1-4 hrs),150mg for 10 days, the treatment of DVT/PE, Prophylaixs of recurrent DVT/PE (18-74), 150mg BD for at least 5 days (75-79 y/o) = 110-150mg BD Adults 80y/o+ = 110mg bd and prophylaxis for stroke - 110-150mg BD

Question 27

Regulars doses, adjustments and reduction: Rivaroxaban

Answer 27

Normal dose - 20mg ONCE daily with food Reason for adjustment - Crcl (15-49 ml/min) Dose reduced to - 15mg OD

Question 28

Regulars doses, adjustments and reduction: Edoxaban

Answer 28

60mg OD Reason for adjustment= Weight less than 61 kg, crcl- 15-50, Drugs - erythromycin, ciclosprin,ketoconazole,dronedarone Dose = 30mg BD

Question 29

Regulars doses, adjustments and reduction: Apixaban

Answer 29

5mg BD At least 2/3 or the following - weight less than 60kg, creatnine more than 133, age more than 8-0 and crcl 15-29 Dose = 2.5mg BD

Question 30

Regulars doses, adjustments and reduction: dabigatran

Answer 30

150mg BD Age more than 8- Drugs - verapamil ( change dose to 110-150 BD), Age 75-79- (110-150) Crcl 30-50 ml/min Dose reduction = 110mg BD

Question 31

Antidotes - Andexanet Alfa (Ondexya) - used for which DOACS?

Answer 31

Rivaroxaban and Apixaban (edoxaban has none)

Question 32

What’s the antidote for Dabigatran?

Answer 32

Idranruzumab (praxbind)

Question 33

What additional label does Apixaban and edoxaban have when dispensing?

Answer 33

Label 10 - Eliquis(2.5 mg and 5mg)- read additional info given with this medication LIXIXIANA- Edoxaban

Question 34

Dabigatran label

Answer 34

25 - swallow whole and don’t chew or crush Pradaxa (75,110,150)

Question 35

Rivaroxaban cautionary label

Answer 35

21 (15mg,20mg) take with food Xareltro - (2.5,10,15,20)