Direct oral anticoagulants in general practice

Nurses prescribing these medications, used for stoke prevention in atrial fibrillation in general practice, must understand the risks surrounding them. This article outlines indications, side effects and monitoring. Four direct oral anticoagulants (DOACs) are available in the UK and appear in National guidance as first line treatment for VTE and stroke prevention in atrial fibrillation. They provide a more practical option than warfarin, with similar efficacy and safety profiles, with the additional advantage of significantly reduced risk of intracranial haemorrhage (Raschi et al 2016). DOACs are not suitable for patients with mechanical heart valves, antiphospholipid syndrome or for women who are pregnant or breastfeeding. DOACs work by inhibiting a single clotting factor, meaning their effects are more predictable than warfarin which works on several clotting factors. Bleeding is the main side effect and safety consideration of DOACs, with major bleeding occurring in around 1-4% of people taking DOACs ( Hellenbart et al 2017 ). Careful risk assessment, patient counselling and at least annual review of patients on DOACs can help to reduce their associated risks.