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New Oral Anticoagulants (NOAC)

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    New oral anticoagulants (NOAC)


    This is a little summary of some of the new oral anticoagulants which have replaced warfarin. The summary points are from an article in Canadian Family Medicine, volume 60 (11): pages 997-1001.


    The NOAC are being used with increased frequency in patients with atrial fibrillation and venous thromboembolism (deep vein clots and pulmonary embolism).


    Dabigatran and rivaroxaban should be taken with meals to decrease dyspepsia and increase absorption, respectively.

    There are no dietary restrictions with any of the NOACs, beyond moderating alcohol intake, and rivaroxaban and apixaban.

    The use of acid suppressive therapies does not appear to affect the efficacy of the NOAC agents.

    As with warfarin, patients taking NOAC should avoid long-term use of nonsteroidal anti-inflammatory medications (e.g. ibuprofen, naproxen) and antiplatelet drugs (aspirin, plavix).

    For patients requiring surgery, generally NOACs should be stopped 2 to 5 days before the procedure, depending on bleeding risk, and the NOAC should usually be resumed at least 24 hours after surgery.

    In patients who develop bleeding, minor bleeding typically does not require laboratory testing or discontinuation of NOAC agents.

    In patients with major bleeding, the focus should be on local measures to control the bleeding and supportive care, and coagulation testing should be performed.

    There are currently no standard antidotes to reverse NOAC agents.

    Very important:  NOAC agents should not be used in patients with valvular heart disease, or prosthetic heart valves.

    Dr Karamanoukian's comment: Although this article states that NOAC agents[should not be used in] cancer-associated deep vein thrombosis, or superficial thrombophlebitis, they are indeed used by most physcians for patients with superficial vein clots.