Antiplatelets

• Aspirin

• Dipryridamole

• Clopidogrel (avoid in pregnancy)

Warfarin

• Still preferred agent for: mechanical valves, rheumatic MV disease, advanced CKD, high-risk thrombophilias (APAS), cancer patients (if LMWH not used) - check

• Usual strategy is to aim for an INR target of 2.5, keeping within the range of 2.0–3.0

Direct oral anticoagulant (DOAC)

Preferred agents for SE London:

• Edoxaban: stroke prevention in non-valvular AF (NVAF): OD and simple dosing regimen (give 1 month supply from hospital)

• Rivaroxaban: VTE management, 2nd-line NVAF, post-ACS, CAD, PAD; LMWH loading not required, OD and simple regimen. (give 3M supply from hospital)

Others / RCGP notes:

• Apixaban

• Dabigatran (avoid in pregnancy)

• Idarucizumab is the first agent to be licensed in the UK that reverses the anticoagulant effect of a NOAC. Specific against dabigatran - indicated in adults who had either serious bleeding or require urgent surgery. People may still need other supportive measures, for example blood products, to manage their bleeding and these should be considered as medically appropriate.)

• Nomenclature: The approval of dabigatran in 2010 lead to the creation of the term new oral anticoagulants (NOACs). This term was changed to novel oral anticoagulants (NOACs) when rivaroxaban came to the market in 2011. After apixaban and edoxaban were cleared, the name changed to direct oral anticoagulants (DOACs) and is the term used by the International Society of Thrombosis and Haemostasis. Alternative names include target-specific oral anticoagulants (TSOACs) and non-vitamin K oral anticoagulants (NOACs). All of these acronyms refer to the same agents.