Factor Xa Inhibitors (DOACs) Flashcards

1
Q

Give 4 examples of DOACs

A
  • Apixaban
  • Dabigatran
  • Edoxaban
  • Rivaroxaban
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2
Q

What is the mechanism of action of DOACs?

A

Directly inhibit factor Xa, thus disrupting the clotting cascade

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3
Q

What is the route of delivery of DOACs?

A

PO

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4
Q

What are the indications for DOACs?

A
  • Treatment and prophylaxis of DVT and PE in hip and knee replacements
  • Stroke prophylaxis in non-valvular AF
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5
Q

What are the contraindications for DOACs?

A
  • Active, clinically significant bleeding
  • Antiphospholipid syndrome
  • Risk factors for major bleeding
  • Haemodynamically unstable patients with PE, or patients who may undergo thrombolysis or pulmonary embolectomy
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6
Q

What are the cautions for DOACs?

A
  • Post-op analgesia with epidural catheter in situ
  • Prosthetic heart valves
  • Hepatic impairment
  • Pregnancy
  • Breastfeeding
  • Renal impairment
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7
Q

At what creatinine clearance should DOACs be used with caution?

A

<15ml/min

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8
Q

What might DOACs interact with?

A

Other anticoagulants (increased risk of bleeding)

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9
Q

What are the common side effects of DOACs?

A
  • Bleeding and bruising

- GI upset, particularly nausea

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10
Q

What are the less common side effects of DOACs?

A

Hepatobiliary disorders

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11
Q

Is INR monitoring required with DOACs?

A

No

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12
Q

What monitoring is required with DOACs?

A
  • Check for signs of bleeding or anaemia

- Check eGFR before and after starting treatment

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13
Q

Why do you need to check eGFR with DOACs?

A

To ensure that baseline renal function is sufficient for drug, and to monitor for future renal impairment

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14
Q

What patient counselling is required with DOACs?

A
  • Compliance
  • Concurrent medications
  • Excessive bleeding
  • Medical alert bracelet
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15
Q

What counselling regarding compliance is required with DOACs?

A

Emphasise the importance of taking the drug as directed. They should be swallowed whole and taken at the same time each day

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16
Q

What counselling regarding concurrent medications is required with DOACs?

A

The patient should not start any medications without consulting a doctor or pharmacist

17
Q

What counselling regarding excessive bleeding is required with DOACs?

A

Warn patient to seek medical help urgently if they experience excessive bleeding or bruising