Cardiology: Non-vitamin K antagonist oral anticoagulants
Non-vitamin K antagonist oral anticoagulants (NOACs) are novel direct-acting medications that are selective for one specific coagulation factor, either thrombin (IIa) or activated factor X (Xa). NOACs have now been integrated into CCG formularies for GPs to prescribe as part of a shared care agreement with a cardiologist/haematologist since NICE approved — specifically — rivaroxaban, dabigatran, and apixaban for use in the treatment and secondary prevention of DVT and PE, and for stroke prevention in patients with atrial fibrillation in 2012. As such, I thought it might be a good idea to refresh our knowledge on the differences between this newer class of anticoagulant and the more traditional oral Vitamin K antagonists (VKAs) that have dominated this field for the last 60 years.
NOACs remain under close scrutiny but many reviews suggest their advantages (most importantly the lack of necessity for monitoring, rapid onset and fewer interactions) outweigh disadvantages (notably expense and the lack of an immediately acting antidote).
I hope to discuss the use of NOACs at Network Locum (now Lantum)'s next CPD event later this year where we will have an entire evening dedicated to cardiology in primary care.
- Dabigatran etexilate for the treatment and secondary prevention of deep vein thrombosis and/or pulmonary embolism; NICE Technology Appraisal Guidance, December 2014
- Apixaban for the treatment and secondary prevention of deep vein thrombosis and/or pulmonary embolism; NICE Technology Appraisal Guidance, June 2015
- Rivaroxaban for the treatment of deep vein thrombosis and prevention of recurrent deep vein thrombosis and pulmonary embolism; NICE Technology Appraisal Guidance, July 2012
- Apixaban for preventing stroke and systemic embolism in people with nonvalvular atrial fibrillation; NICE Technology Appraisal Guidance, February 2013
- Dabigatran etexilate for the prevention of stroke and systemic embolism in atrial fibrillation; NICE Technology Appraisal Guidance, March 2012
- Rivaroxaban for the prevention of stroke and systemic embolism in people with atrial fibrillation; NICE Technology Appraisal Guidance, May 2012
- Mekaj YH, Mekaj AY, Duci SB, et al; New oral anticoagulants: their advantages and disadvantages compared with vitamin K antagonists in the prevention and treatment of patients with thromboembolic events. Ther Clin Risk Manag. 2015 Jun 24;11:967-77. doi: 10.2147/TCRM.S84210. eCollection 2015.