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
| Dabigatran | Rivaroxaban | Apixaban | |
|---|---|---|---|
| Mechanism of action | Direct thrombin inhibitor | Direct factor Xa inhibitor | Direct factor Xa inhibitor |
| Route | Oral | Oral | Oral |
| Excretion | Majority renal | Majority liver | Majority faecal |
Indications
The table below summaries the three DOACs: dabigatran, rivaroxaban and apixaban.
*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:
| Dabigatran | Rivaroxaban | Apixaban | |
|---|---|---|---|
| UK brand name | Pradaxa | Xarelto | Eliquis |
| NICE indications | 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* | 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