Direct oral anticoagulants (DOACs)

1
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• Direct Oral Anticoagulants
• (DOACs)
• Anwer Ghani
• FIBMS
• Iraq

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• Direct oral anticoagulants (DOACs) have quickly
  become attractive alternatives to the
  long-standing standard of care in
  anticoagulation, vitamin K antagonist.
• Since the first approval in 2010, DOACs have
  emerged as leading therapeutic alternatives that
  provide both clinicians and patients with more
  effective, safe, and convenient treatment options
  in thromboembolic settings.

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• Direct oral anticoagulants (DOACs)dabigatran
  (Pradaxa), rivaroxaban (Xarelto), apixaban
  (Eliquis), edoxaban (Savaysa), and betrixaban
  (Bevyxxa) are anticoagulation pharmacotherapy
  used for the prevention of thrombosis in several
  cardiovascular contexts.
• DOACs are categorized into 2 main classes oral
  direct factor Xa inhibitors (ie, rivaroxaban,
  apixaban, edoxaban, and betrixaban) and direct
  thrombin inhibitors (ie, dabigatran).

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• DOACs are relatively new agents demonstrating
  superiority or noninferiority to prior standards
  of care, anticoagulation with vitamin K
  antagonists (VKA ie, warfarin), or
  low-molecular-weight heparins (LMWHs), in
  reducing risk of thromboembolic complications
  with similar or reduced bleeding risk.
• Advantages of DOACs compared with VKAs include
  fewer monitoring requirements, less frequent
  follow-up, more immediate drug onset and offset
  effects.
• DOAC prescriptions exceeded those for warfarin by
  2013, with apixaban being the most frequently
  prescribed DOAC for patients with nonvalvular
  atrial fibrillation (NVAF).

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• Dabigatran, rivaroxaban, apixaban, and edoxaban
  are approved for the lowering the risk of stroke
  and embolism in NVAF as well as deep vein
  thrombosis and pulmonary embolism
  treatment/prophylaxis.

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• Unique indications include betrixaban for
  prophylaxis of venous thromboembolism (VTE) in
  hospitalized patients for an acute medical
  illness, and rivaroxaban in combination with
  aspirin to reduce major cardiovascular events in
  patients with chronic coronary artery disease
  (CAD) or peripheral artery disease.

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AF and PCI

• Dual therapy rivaroxaban (15 mg ) and a P2Y12
  inhibitor ( clopidogrel) or
• Triple therapy with rivaroxaban 2.5 mg twice
  daily plus DAPT
• lower bleeding risk in comparison to triple
  therapy (VKA at standard AF dosing, aspirin, and
  clopidogrel but similar thrombotic events.
• Dabigatran (150 mg twice-daily) same.

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AF and Artificial Heart Valves

• VKA remains the preferred agent for this patient
  population .
• bioprosthetic acceptable (need study).

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Atrial Fibrillation With Stable Coronary Disease

• The rivaroxaban monotherapy arm was noninferior
  than combination ( DOACAP) in cardiovascular
  efficacy measures and superior in reducing major
  bleeding. combination

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Cancer-Associated Thromboembolism

• DOAC are not inferior than LMWH in treatment and
  prevention of VTE in cancer patient.

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CKD

• all are renal excretion.
• Apixoban is the least.
• Dose reduction if agegt65, wtlt60 and scrgt1.5.

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THANKS

• REFERENCE
• https//www.ahajournals.org/doi/full/10.1161/JAHA.
  120.017559