Out With the NOACs

Novel oral anticoagulants (NOACs) were developed as an alternative treatment for systemic anticoagulation and for prophylaxis for venous thromboembolism, Thomas Aaron VanDruff, adjunct faculty, Georgetown University School of Nursing and Health Sciences, said during a session Monday, about the use of NOACs as an alternative treatment.

During the session “Novel Anticoagulant Therapies: Prevention and Management of Thromboembolism with New Medications,” VanDruff discussed indications and dosing for the three most common NOACs — dabigatran, rivaroxaban and apixaban — and how they impact the clotting cascade.

“In the past, we have had an issue with treatment of patients with either deep vein thrombosis and pulmonary emboli,” VanDruff said. “For a long time, the most common treatment was a heparin drip in the hospital, and to go home on warfarin, which requires frequent monitoring. There is a lot variability in the way in which warfarin works in individuals.”

One benefit of NOACs is that they do not require routine monitoring, unlike the traditional treatment. In addition, they are less influenced by diet and other medications, and they have a rapid time of onset and quickly reach peak action. VanDruff said, “For most people, they are very predictable and safe drugs.” Still, there are some considerations regarding dosing, especially with patients who are elderly, underweight or at a higher risk for bleeding, or with patients who have low muscle mass or renal impairment.

Attendees of the session learned how to speak knowledgeably with patients and providers about these alternative treatments. “Providers can hopefully get more comfortable with thinking about and prescribing a newer therapy that may have real benefits for their patients over what they are used to prescribing in the past,” said VanDruff. “NOACs can simplify the process for both patients and providers.”