Hematology

DOACs - Dabigatran, Rivaroxaban, Apixaban song

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DOACs - Dabigatran, Rivaroxaban, Apixaban

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Key points in this song10

Dabigatran is a direct thrombin inhibitor (Factor IIa); rivaroxaban and apixaban are direct Factor Xa inhibitors — mechanism determines reversal agent selection.
Idarucizumab is the specific reversal agent for dabigatran; andexanet alfa reverses Factor Xa inhibitors (rivaroxaban, apixaban).
Unlike warfarin, DOACs require no routine INR monitoring and have predictable pharmacokinetics with fixed dosing.
Dabigatran requires dose reduction in renal impairment and is contraindicated in severe renal failure (CrCl <15 mL/min) due to 80% renal excretion.
Apixaban is preferred in patients with renal insufficiency among the Xa inhibitors because it has the least renal clearance (~27%).
DOACs are approved for stroke prevention in non-valvular atrial fibrillation, treatment of DVT/PE, and VTE prophylaxis; they are NOT used with mechanical heart valves.
Dabigatran is the only DOAC that can be dialyzed due to low protein binding (~35%), making it useful in overdose management.
All DOACs have a faster onset than warfarin (1–4 hours to peak), eliminating the need for heparin bridging in most indications.
The APIXABAN "2-5-60 rule" triggers dose reduction: ≥2 of the following — age ≥80, weight ≤60 kg, creatinine ≥1.5 mg/dL.
DOACs interact with P-glycoprotein and CYP3A4 inducers/inhibitors; rifampin (inducer) significantly reduces DOAC levels, increasing thrombotic risk.