References
Direct oral anticoagulants in general practice
Abstract
Nurses prescribing these medications, used for stoke prevention in atrial fibrillation in general practice, must understand the risks surrounding them. This article outlines indications, side effects and monitoring.
Four direct oral anticoagulants (DOACs) are available in the UK and appear in National guidance as first line treatment for VTE and stroke prevention in atrial fibrillation. They provide a more practical option than warfarin, with similar efficacy and safety profiles, with the additional advantage of significantly reduced risk of intracranial haemorrhage (Raschi et al 2016). DOACs are not suitable for patients with mechanical heart valves, antiphospholipid syndrome or for women who are pregnant or breastfeeding. DOACs work by inhibiting a single clotting factor, meaning their effects are more predictable than warfarin which works on several clotting factors. Bleeding is the main side effect and safety consideration of DOACs, with major bleeding occurring in around 1-4% of people taking DOACs (Hellenbart et al 2017). Careful risk assessment, patient counselling and at least annual review of patients on DOACs can help to reduce their associated risks.
Direct oral anticoagulants (DOACs) have provided a practical option for people requiring anticoagulation for several indications for over a decade now. Their advantages include a more predictable effect than vitamin K antagonists such as warfarin, with infrequent monitoring requirements, regular fixed doses, no food or drink interactions and few drug interactions (Baglin 2013). Four DOACs are currently licensed for use in the UK: dabigatran etexilate, rivaroxaban, apxixaban and edoxaban. National clinical guidelines now promote DOACs as first line treatment for venous thromboembolism (VTE) and prevention of stroke in non-valvular atrial fibrillation (AF).
The landmark phase III clinical trials of all four DOACs showed similar efficacy and safety to warfarin, with significantly reduced risk of intracranial haemorrhage (Raschi et al 2016). Real-world registry data has largely reflected these clinical trial findings, providing reassurance that these medicines offer a safe and practical option for patients requiring anticoagulation (Beyer-Westendorf et al 2013, Agnelli et al 2015, Camm et al 2016, Hecker et al 2016).
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