Updates on the non-vitamin K oral anti-coagulants (NOACs)

Document Type : Review Articles

Author

Department of Anesthesia, Critical Care and Pain Management, Faculty of Medicine, Ain Shams University, Cairo, Egypt.

Abstract

Non-vitamin K oral anti-coagulants (NOACs), are direct oral anticoagulants (DOACs), two classes of DOACs are available; reversible thrombin inhibitor (Dabigatran) and the active factor (Xa) inhibitors (Rivaroxaban, apixaban, betrixaban and edoxaban).
Main body: NOACs offer rapid onset of action, fast time to effect, few food and drugs interactions and no need for international normalized ratio (INR) monitoring, with improved patient compliance over warfarin. Local hemostatic measures and withholding the next dose achieve hemostasis in patients presenting with minor bleeding, waiting for drug clearance. Administration of reversal agents is considered in patients with major bleeding, or those requiring rapid reversal for emergency surgery. The Food and Drug Administration (FDA) has approved two reversal agents; idarucizumab for dabigatran and andexanet alfa for apixaban and rivaroxaban. Several agents are in different phases of clinical trials; with ciraparantag showing promising results. The high cost and limited availability remain a concern in their use.
Conclusion: NOACs offer better patient compliance, with reversal agents need for patients presenting with major bleeding.

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