for patients with we go through his medications and we notice that he is on

two tablets of the five milligram eloquence

quite stately. Oh God. In addition to aspirin,

great. In addition to aspirin. So someone's trying to kill him.

Welcome to the curbsiders, an internal medicine podcast where we deconstruct topics

to provide listeners with clinical pearls and practice changing knowledge.

I'm Dr. Matthew Wato here with my co-host Dr. Tony Siddari and Dr. Stuart Brigham.

Hey Matt. Hi. On this episode we'll be discussing the new oral anti-coagulence,

which are called noax in some of the literature. They're also called direct oral anti-coagulence

or doax. In general, we'll be calling them noax or new oral anti-coagulence on this episode.

I'll give you a brief overview up front to kind of help put things in perspective.

The new oral anti-coagulence are now becoming widely used largely because they're much more

convenient than warfarin and have a similar safety and efficacy. These agents include the bigotran,

riveroxaban, epixaban, and edoxaban. All these agents are approved for non-valvular

atrial fibrillation. However, it should be noted that patients with valvular a-fibre prosthetic

heart valves should not be placed on these agents because trials with the bigotran showed increased

risk of thrombotic complications. And there have not been sufficient trials to say whether they're

safety or efficacy to use the 10A inhibitors. The agents are all approved for the treatment of

venous thromboembolism, riveroxaban, and epixaban can be used up front as treatments for venous thrombo

embolism without any proceeding parantral anti-coagulation. However, the bigotran and edoxaban

require five to ten days of parantral anti-coagulation with something like unfractionated heparin or

a low molecular weight heparin prior to using them. Some of the agents, riveroxaban and epixaban,

...