Role of novel oral anticoagulants in the management and prevention of venous thromboembolism

Table 4 Practical guide to use

When considering the use of a NOAC, there are important steps that should be considered:

(1) Consideration as to whether anticoagulation is necessary

Does the patient have a confirmed indication for anticoagulation?

Did the patient have a transient risk factor for VTE that has resolved or did they have an unprovoked VTE and should be considered for extended treatment?

(2) Consideration as to whether a NOAC is the most appropriate choice

Does the patient have normal renal and liver function?

Does the patient have an underlying malignancy for which LMWH may be a more appropriate alternative?

(3) Review of any other medications that may be contra-indicated or pose unfavourable drug-drug interactions

Potent inhibitors: ketoconazole, itraconazole, voriconazole, posaconazole

Potent inducers: rifampicin, carbamazepine, phenytoin, phenobarbital, HIV protease inhibitors

(4) Education regarding the importance of compliance and bleeding risk

Due to the short half life, there is a rapid decline in protective anticoagulation

(5) Regular follow-up to assess:

Therapy adherence

Potential thromboembolic event

Any adverse events

Bleeding events

Co-medications

Blood tests for haemoglobin, renal and hepatic function

(6) Assessment to determine whether ongoing anticoagulation is necessary and beneficial

NOAC: Novel oral anticoagulant; LMWH: Low molecular weight heparin; HIV: Human immunodeficiency virus; VTE: Venous thromboembolism.