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NOAC-CHOOSING BETWEEN NOACs

Haematology

NOAC-CHOOSING BETWEEN NOACs

1. Factors to consider when deciding between the NOACs include the patient’s likelihood to comply with twice daily (dabigatran,
apixaban) versus single, daily (rivaroxaban) treatment, and drug interactions with other concomitant chronic medications.

2. The most important interactions are with verapamil and amiodarone, which can increase NOAC concentrations.

3. This effect is minimised by ingestion of the anticoagulant drug at least 2 hours before ingestion of the other medications.

4. Rivaroxaban & apixaban should not be co-administered with azone antifungals or HIV protease inhibitors.

5. In the AF studies, GIT bleeding was encountered more frequently with dabigatran & rivaroxaban than with warfarin; this was not the case for apixaban.

6. If a patient has a predisposition to this condition (untreated ulcer symptoms, previous GIT bleeding), apixaban or warfarin may be more prudent options.


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REFERENCES

1. Wilkinson, I. (2017). Oxford handbook of clinical medicine. Oxford: Oxford University Press.
2. Hannaman, R. A., Bullock, L., Hatchell, C. A., & Yoffe, M. (2016). Internal medicine review core curriculum, 2017-2018. CO Springs, CO: MedStudy.
3. Image: no reference available.

Ⓒ A. Manickam 2018

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