Examples: Rivaroxaban, Apixaban, Dabigratran, Edoxaban
Indications: prevention of stroke in atrial fibrillation, deep vein thrombosis, pulmonary embolism, prophylaxis after hip or knee surgery
Role in Therapy:
less types of bleeding, somewhat less drug interactions and no need for blood monitoring compared to warfarin
Dosing (Atrial Fibrillation):
Rivaroxaban, edoxaban: once daily
Apixaban, dabigatran: twice daily
Rivaroxaban: take with food if dose is 15 or 20 mg *enhances absorption
*Must dose reduce in renal dysfunction
Adverse Effects:
-Bleeding of course! By thinning the blood, each agent has different types of bleeding risks in comparison to warfarin. If bleeding occurs, there are reversal agents (Praxbind (Idarucizumab) for dabigratran, and Andexxa (andexanet alfa) for rivaroxaban, edoxaban & apixaban)
-GI upset and diarrhea with dabigatran
Drug Interactions: Many!
-CYP3A4 and pg-p inhibitors: may increase anticoagulant levels and increase risk of bleeding (common examples are diltiazem, verapamil, ketoconazole, clarithromycin)
-CYP3A4 inducers (phenytoin, carbamazepine): may lead to reduced anticoagulant level --> ineffective treatment may put patients at risk for stroke or deep vein thrombosis
-other agents which increase bleeding such as NSAIDs and antiplatelet agents
Additional: store dabigatran in original containers because of sensitivity to moisture