Novel oral anticoagulants (NOACs)

A number of new anticoagulants have recently been approved by NICE (The National Institute for Health and Clinical Excellence) to prevent stroke in certain patients with AF.

Advantages

Drugs such as Dabigatran and Rivaroxaban work in a similar manner to Warfarin but are metabolized more consistently hence dosing is easier and regular blood tests are not required. These new anticoagulants have shown promising results in recent clinical trials.  At present these drugs tend to be reserved for individuals who have difficulties taking Warfarin.

Mechanism of action

Similarly to Warfarin, the NOACs inhibit components of the clotting pathway preventing clot formation in the blood.  Dabigatran inhibits thrombin whereas Rivaroxaban and Apixaban both inhibit factor Xa.

Potential side-effects

The main complication to monitor for is bleeding. This may present with bruising, a rash, pink or red urine, black or red stool, dizziness or altered conscious level. Other possible side-effects include a stomach upset (for example indigestion, diarrhoea and constipation), nausea, itch and dizziness.

 For more information see Surrey NOAC Guidelines 2013