Direct Oral Anticoagulants (DOACs)

person writingRecently, several new direct oral anticoagulants (DOACs) have been approved by the United States Food & Drug Administration (FDA) that do not require regular blood monitoring. These medications work by interfering with various processes involved in the production of fibrin, an essential component of blood clots.

DOACs are both rapid- and short-acting agents with relatively low bleeding risks and good overall safety profiles. They are considered to be at least as effective as warfarin. Available medications in this category include apixaban (Eliquis®), betrixaban (BevyxXa®), dabigatran (Pradaxa®), edoxaban (Savaysa®) and rivaroxaban (Xarelto®). Others are in various stages of clinical study.

DOACs are an alternative to conventional therapy for blood-clot treatment in appropriately selected patients. Unlike warfarin, DOACs do not require regular laboratory monitoring and are not affected by food or alcohol. However, DOACs tend to be more expensive than warfarin and are shorter acting, making it important not to miss any doses, as this can quickly expose patients to insufficient anticoagulant protection. In addition, some DOACs require  twice-daily dosing that, when compared to warfarin’s once-per-day administration, may lead to higher rates of non-compliance.

Although other blood thinners have available antidotes to reverse anticoagulant effects if necessary, only one DOAC, dabigatran, has an approved antidote. Therefore, most DOACs are not suitable for patients who may require immediate reversal, such as those with a history of gastrointestinal bleeding or individuals who may need emergency surgery.

Advantages of Direct Oral Anticoagulant Medications

  • Rapid onset
  • Rapid offset
  • No required blood monitoring
  • Fewer drug, supplement and dietary interactions

Disadvantages of Direct Oral Anticoagulant Medications

  • More expensive blood thinners than warfarin
  • Twice-daily dosing may increase chance for non-compliance
  • Few available antidotes in case of complications

Potential Side Effects of Direct Oral Anticoagulant Medications

  • Uncontrolled bleeding (most serious side effect)

Animal studies of some DOACs suggest the potential for fetal harm, so pregnant women and those planning a pregnancy should discuss LMWH as the preferred therapy with their doctor.

As with all blood thinners, patients should avoid aspirin and other NSAIDS and wear or carry identification stating that they are taking anticoagulants.

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