Directly acting oral anticoagulants





Introduction

Directly acting oral anticoagulants (DOACs) were developed as an alternative to warfarin. Unlike warfarin, they do not require routine monitoring and are therefore considered more convenient to patients.

Mechanism of action

DabigatranRivaroxabanApixaban
Mechanism of actionDirect thrombin inhibitorDirect factor Xa inhibitorDirect factor Xa inhibitor
RouteOralOralOral
ExcretionMajority renalMajority liverMajority faecal

Indications

The table below summaries the three DOACs: dabigatran, rivaroxaban and apixaban.

DabigatranRivaroxabanApixaban
UK brand namePradaxaXareltoEliquis
NICE indicationsPrevention of VTE following hip/knee surgery

Treatment of DVT and PE

Prevention of stroke in non-valvular AF*
Prevention of VTE following hip/knee surgery

Treatment of DVT and PE

Prevention of stroke in non-valvular AF*
Prevention of VTE following hip/knee surgery

Treatment of DVT and PE

Prevention of stroke in non-valvular AF*

*NICE stipulate that certain other risk factors should be present. These are complicated and differ between the DOACs but generally require one of the following to be present:
  • Prior stroke or transient ischaemic attack
  • Age 75 years or older
  • Hypertension
  • Diabetes mellitus
  • Heart failure