DOAC - Monitoring

CrCl > 60ml/min

Annual U&E FBC and LFTs

CrCl between 30-60ml/min and/or aged >75 years and/or frail

6 monthly U&E FBC and LFTs

Dyspepsia common with dabigatran; consider PPI or alternative agent Other side effects: Review dose? Switch to alternative agent?

NB: DOACs are ‘black triangle’ drugs – All adverse drug events must be reported to MHRA via https://yellowcard.mhra.gov.uk/

For example, can anticoagulant therapy be stopped in patients with prior DVT / PE, where the risk of recurrence is now considered low – seek specialist advice if necessary

Has their bleed risk increased

• See guidance on DOAC dosing
• avoid use of DOACs if <CrCL 30 mL/min (dabigatran contraindicated)
• If edoxaban is used for AF, review choice of agent if CrCL >95mL/min as efficacy is reduced)
• avoid if weight is ​<50kg or >120kg.

≥3 means at increased bleeding risk

• Correct potentially reversible risk factors
• Ensure more frequent reviews are in place
• Check for any bleeding episodes “nuisance bleeding’ – are preventative measures possible?
• Reinforce importance of carrying ‘patient alert’ card at all times

• Persistent nausea, stomach upset, or vomiting blood or other material that looks like coffee grounds
• Headaches, dizziness, or weaknes
• Nosebleeds
• Dark red or brown urine
• Blood in the bowel movement or dark-colored stool

 Treatment should be stopped if severe bleeding occurs

see managing bleeding complications