Direct Oral Anticoagulants (DOACs) for NVAF
Apixaban
- (FXa inhib)
- 5 mg bid (2.5 mg bid if ≥ 2 of: ≥80 y, ≤60 kg, Cr ≥1.5 mg/dL)
- ≈ ischemic stroke & ↓ major bleed incl ICH,
- 11% ↓ death. In Pts felt not cand for warfarin, apixa 55% ↓ stroke w/o ↑ bleed vs ASA alone.
Rivaroxaban
- (FXa inhib)
- 20 mg qd (15 mg qd if CrCl 15–50) w/ pm meal
- ≈ ischemic stroke & major bleeds, but ↓ fatal bleed incl ICH
Edoxaban
- (Fxa inhib)
- 60 mg qd if CrCl 51–95 (30 mg if CrCl 15–50)
- ≈ ischemic stroke & ↓ major bleed incl ICH, 14% ↓ CV death. ↑ ischemic CVA if CrCl >95.
Dabigatran
- (Thromb inhib)
- 150 mg bid (75 mg bid if CrCl 15–30)
- 150 mg: ↓ ischemic stroke & ICH, but ↑ GIB
- Risks: GI side effects, ↑ MI c/w warfarin
Onset w/in hrs. Reversal: andexanet for FXa inhib; idarucizumab for dabi; 4F-PCC. %