- Assess stroke risk to determine whether oral anticoagulation is recommended, then identify and manage modifiable bleeding risk factors.
- Discuss benefits, harms and lifestyle factors with each patient, when selecting and reviewing oral anticoagulant medicines.
- All people prescribed an oral anticoagulant medicine need individualised clinical monitoring.
Predicting risk with oral anticoagulants
Apixaban (Eliquis), dabigatran (Pradaxa), rivaroxaban (Xarelto) and warfarin (Coumadin or Marevan) can all be considered for the prevention of stroke and systemic embolism in adults with non-valvular atrial fibrillation.
Their safe and effective use relies on balancing the benefits of blood clot prevention with the risks of bleeding – whichever anticoagulant is selected.
Idarucizumab (Praxbind) for dabigatran (Pradaxa) reversal: what you should know
Idarucizumab is a specific non-vitamin K antagonist oral anticoagulant (NOAC) reversal agent that can reverse the anticoagulant effects of dabigatran. It does not reverse warfarin or the other NOACs.
Idarucizumab is now available in Australia. What do you need to know?
Australian Prescriber: Long-term prescribing of new oral anticoagulants
Paul KL Chin and Matthew P Doogue
Aust Prescr 2016;39:200–4
The choice of anticoagulant depends on the characteristics of the patient and the medicine. Instead of considering whether non-vitamin K antagonist oral anticoagulants are ‘superior’ to warfarin, it is more constructive to see them as useful arrows in the prescriber’s quiver of oral anticoagulants.
Quick primer on idarucizumab and NOAC-associated bleeding
RADAR: Aspirin and an oral anticoagulant – can they be used together?
A recent meta-analysis showed that in patients receiving single low-dose aspirin, additional treatment with an oral anticoagulant decreased the rate of major adverse cardiovascular events by 30% but clinically significantly increased the rate of bleeding events by 79%.
- Pharmacy Practice Review: Oral anticoagulants: promoting safe use
- Journal Reading: How to manage warfarin therapy
- Journal Reading: Long-term prescribing of new oral anticoagulants
For students - National Prescribing Curriculum