Blog

Aaron Goodman: Effects of DOACs on Tests of Hemostasis

Photo from Aaron Goodman/X

Jun 7, 2024, 11:38

Aaron Goodman: Effects of DOACs on Tests of Hemostasis

Aaron Goodman shared a post on X:

”DOAC Jewels – Tweetorial.

Effects of DOACs on Tests of Hemostasis.

All increased PT (dabigatran slightly).
All increased PTT (rivaroxaban/apixaban very slightly).

Mixing studies demonstrate incomplete correction.

Dabigatran can falsely increase fibrinogen. Only dabigatran increases TT.

Aaron Goodman

Anticoagulant Mechanism Name Jewels!

Drugs target Xa = Xa in name:

ApiXaban,
BetriXaban,
EdoXaban,
RivaroXaban.

Drugs target BOTH Xa+thrombin = PARIN (pair) in name:

HeParin,
EnoXaParin,
DalteParin.

Drugs target only IIa = B (2nd letter):

ArgatroBan,
Bivalrudin,
DaBigatran.

DOACs and Renal Impairment.

% Renal Excretion:

Dabigatran: 80%,
Rivaroxaban: 66%,
Edoxaban: 40%,
Apixaban: 25%,
Betrixaban: 11%.

To remember order from worst to best to give for patients with renal impairment: DR. Ed ABe.

Aaron Goodman

Lets reverse this now!

Warfarin equals the inhibition of factors II,VII,IX,X.
Reverse equals Vitamin K, 4 factor PCC (II,VII, IX, X).
Heparin equals the inhibition of factors II,X.
Reverse equals the Protamine (binds heparin).
Dabigatran equals the inhibition of factor II.
Reverse equals Idacrucizumab (MAB to dabigatran).
Xa inhibitors (Apixaban).
Reverse equals Andexanet (Xa decoy binds drug).”

Source: Aaron Goodman/X

Aaron Goodman is a Hematologist/ Oncologist and an Associate Professor of Medicine at the University of California, San Diego. He is a member of the National Comprehensive Cancer Network (NCCN) guideline committee for both cutaneous NHLs and T-cell NHLs. Dr. Goodman is a well-known physician-scientist, educator, advocate, and social media influencer.