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Dabigatran
(Pradaxa)
Rivaroxaban
(Xarelto)
Apixaban
(Eliquis)
Drug Classification
- Nonvalvular AF
- Treatment of VTE & PE
- Reduce risk of recurrent VTE &
PE
- Nonvalvular AF
- Treatment of VTE & PE
- Reduce risk of recurrent VTE
or PE
- VTE prophylaxis (hip & knee)
Relative
risk
reduction
compared
to
warfarin
- Nonvalvular AF
- Treatment of VTE & PE
- Reduce risk of recurrent VTE or
PE
- VTE prophylaxis (hip & knee)
- FDA approved for nonvalvular
AF patients on hemodialysis
ARISTOTLE (5 and 2.5 mg)
AMPLIFY and AMPLIFY-EXT
21% (CHADS2 2.1), superior to
warfarin
49%
No increase
5-9 hrs
9-12 hrs (elderly)
8-15 hrs
2 hrs
2-4 hrs
3 hrs
Elimination
80% renal
20% biliary
AF:
150 mg BID
If CrCl 15-30 use 75 mg bid
66% renal
33% biliary
AF:
20 mg DAILY with pm meal
If CrCl 15-50 use 15 mg daily
25% renal
75% biliary
AF:
5 mg BID
Reduce from 5 mg to 2.5 mg
BID for pts with 2 of 3 highrisk criteria: age 80, wt 60
kg, creat 1.5
Can be given to pts on HD
Trial: AF:
VTE/PE:
Stroke &
embolism
ICH
GIB
Half-life
Dosage
Pre-op
Post-op
Drug Interactions
Disadvantages
Pricing
Start NOAC 2 hrs before the time to next subcutaneous anticoagulant dose
References:
European Heart Rhythm Association Practical Guide on the use of new oral anticoagulants in patients with non-valvular atrial fibrillation
(2013) 15, 625-651.
Chest Supplement, Antithrombotic Therapy and Prevention of Thrombosis, 9th edition, ACCP.