Suggested follow-up checklist for patients taking a NOAC
| Domains . | Rationale . | Examples . | |
|---|---|---|---|
| A | Adherence assessment and counseling | Potentially preventable thrombosis can occur if NOACs are not administered correctly | • Review medication adherence |
| • Reinforce importance of taking NOAC as prescribed | |||
| • Remind patients to take rivaroxaban with food for optimal bioavailability | |||
| • Plan for interruption and resumption of NOACs for elective procedures associated with a bleeding risk | |||
| • Avoid interruption for very-low-bleeding-risk procedures | |||
| B | Bleeding risk assessment | Bleeding can be potentially avoided if risk factors are recognized and managed | • Avoid concomitant aspirin (if not indicated), NSAIDs, and excessive alcohol consumption |
| In those with a bleeding event, potential bleeding or thrombosis could be prevented by ensuring appropriate interruption and resumption of NOACs | • Assess BP and treat hypertension to minimize risk of ICH | ||
| • Assess for dosing error and prescribe the appropriate dose (Table 1) | |||
| C | CrCl | Potentially preventable bleeding can occur, because NOACs are cleared renally | • If renal function deteriorates, then NOACs may need to be discontinued, switched to alternative anticoagulants, or dose adjusted (Table 1) |
| D | Drug interactions | Potentially preventable thrombosis or bleeding can occur if NOACs are taken with potent P-glycoprotein or CYP450 inducers or inhibitors | • Check for concomitant medications for clinically significant interactions |
| Domains . | Rationale . | Examples . | |
|---|---|---|---|
| A | Adherence assessment and counseling | Potentially preventable thrombosis can occur if NOACs are not administered correctly | • Review medication adherence |
| • Reinforce importance of taking NOAC as prescribed | |||
| • Remind patients to take rivaroxaban with food for optimal bioavailability | |||
| • Plan for interruption and resumption of NOACs for elective procedures associated with a bleeding risk | |||
| • Avoid interruption for very-low-bleeding-risk procedures | |||
| B | Bleeding risk assessment | Bleeding can be potentially avoided if risk factors are recognized and managed | • Avoid concomitant aspirin (if not indicated), NSAIDs, and excessive alcohol consumption |
| In those with a bleeding event, potential bleeding or thrombosis could be prevented by ensuring appropriate interruption and resumption of NOACs | • Assess BP and treat hypertension to minimize risk of ICH | ||
| • Assess for dosing error and prescribe the appropriate dose (Table 1) | |||
| C | CrCl | Potentially preventable bleeding can occur, because NOACs are cleared renally | • If renal function deteriorates, then NOACs may need to be discontinued, switched to alternative anticoagulants, or dose adjusted (Table 1) |
| D | Drug interactions | Potentially preventable thrombosis or bleeding can occur if NOACs are taken with potent P-glycoprotein or CYP450 inducers or inhibitors | • Check for concomitant medications for clinically significant interactions |
Adapted from Gladstone et al.36