Page 76 - Radiology Book

anticoagulants
novel oral anticoagulants (noac)
Mechanism
Dabigatran (Pradaxa®) Direct thrombin (IIa)
Rivaroxaban (Xarelto®) Direct Factor Xa inhibitor
Apixaban (Eliquis®) Direct Factor Xa inhibitor
Use
nonvalvular AFIB, VTE (DVT, PE) Tx after 5-10 days of parenteral anticoag Tx, reduce risk of recurrent VTE in previously treated patients
nonvalvular AFIB, VTE Tx and secondary prevention, VTE prophylaxis post-hip/knee replacement
nonvalvular AFIB, VTE Tx (following initial therapy) and VTE prophylaxis post-hip/ knee replacement
Renal
Renal Adjustment required, increases INR and aPTT
Dosing
Twice daily
Once daily Contraindicated in <18 yo
Twice daily
2.5 mg PO bid if >80 yo and
Age
>75 yo increased major bleed
Considerations
<60 kg or SCr >1.5 mg/dL
Monitoring
No; aPTT and thrombin time (TT) used to detect & if normal suggest low levels
No; PT and anti-Xa levels used to detect & if normal suggest low levels
No; prolongs INR, PT and aPTT, low PT/INR and/or anti-Xa levels suggest lower levels
Drug Interactions
Avoid: rifampin, St. John’s Wort (SJW), possibly carbamazepine
Avoid: carbamazepine, conivaptan, indinavir, Avoid: carbamazepine, ritonavir, itraconazole, ketoconazole, phenytoin, rifampin, SJW lopinavir, phenytoin, rifampin, SJW
Reversal Agent
Idarucizumab (Praxbind)
no reversal agent available
Southfield16
inhibitor
Caution with many medications - Check your institutional prescribing and treatment guidelines
AnticoAgulAtion