DOACs on the NCLEX
Direct oral anticoagulants: indications, no routine monitoring, reversal agents, when to avoid.
Direct oral anticoagulants (DOACs) replaced warfarin for many indications. The NCLEX tests indications, reversal, and when warfarin remains preferred.
Common drugs
Apixaban (Eliquis), rivaroxaban (Xarelto), edoxaban (Savaysa), dabigatran (Pradaxa).
Indications
AFib stroke prevention, DVT/PE treatment and prophylaxis. Not for mechanical valves, warfarin remains standard.
Monitoring
No routine INR or aPTT needed. Renal function monitoring (most are renally cleared). Periodic CBC.
Reversal
Apixaban/rivaroxaban: andexanet alfa (Andexxa). Dabigatran: idarucizumab (Praxbind). Both expensive and bleeding-emergency only.
When to choose warfarin instead
Mechanical valves. Severe renal failure (CrCl <15-30). Antiphospholipid syndrome with triple positivity. Patient preference for routine monitoring.
Frequently asked
Missed a DOAC dose?
Apixaban/rivaroxaban: take when remembered if within 6 hours; otherwise skip. Dabigatran similar.
Can I crush DOACs?
Apixaban can be crushed and mixed in food. Rivaroxaban can be crushed for some doses. Dabigatran, no, capsule shell matters.
Quick check
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