Thursday, 1 May 2014


There are two main NOACs (Noval Oral Anti-Coagulants) that we are seeing used now. They have limited indications, but these will increase as their trials continue:
- VTE prophylaxis following hip and knee replacement surgery - apixaban, dabigatran and rivaroxaban
- Prevention of stroke and systemic emboli in patients with non-valvular AF - apixaban, dabigatran and rivaroxaban
- Treatment of and secondary prevention of DVT and PE - rivaroxaban 

All of these NOACs work further along the clotting cascade than we are used to, which limits reversal options. 

Direct thrombin inhibitor
BD dosing with predictable pharmacokinetics, as no cytochrome p450 interaction. 

Rivaroxaban:  factor Xa inhibitor. Not as much information available - I think similar measures apply. 


   - stop Dabigatran
   - assess severity (if mild just skip a dose)
   - control source of haemorrhage
   - do coagulation screen (APTT, TT)
   - check time of last dose and discuss with Haematology
   - correct co-existant bleeding diathesis e.g. platelets if < 80
   - oral charcoal if ingested within 2 hours
   - haemodialysis (particularly if in renal failure) -> removes ~60% over 2-3 hours


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