From the Guidelines
Direct Oral Anticoagulants (DOACs) are recommended for patients with atrial fibrillation, acute coronary syndromes, or undergoing percutaneous intervention, as they mitigate bleeding risk and prevent thromboembolism, with a preference for DOACs over vitamin K antagonists (VKAs) in eligible patients. The indications for DOACs include:
- Atrial fibrillation with an indication for concomitant antiplatelet therapy, where a DOAC is recommended in preference to a VKA to mitigate bleeding risk and prevent thromboembolism 1
- Acute coronary syndromes, where early cessation of aspirin and continuation of an oral anticoagulant (preferably DOAC) with a P2Y12 inhibitor (preferably clopidogrel) for up to 12 months is recommended to avoid major bleeding, if the risk of thrombosis is low or bleeding risk is high 1
- Percutaneous intervention, where early cessation of aspirin and continuation of an oral anticoagulant and a P2Y12 inhibitor (preferably clopidogrel) for up to 6 months is recommended to avoid major bleeding, if ischemic risk is low 1 The choice of DOAC and dosing should be individualized, with considerations for bleeding risk and thromboembolic risk, and specific dosing recommendations include:
- Rivaroxaban 15 mg once daily may be considered in preference to rivaroxaban 20 mg once daily when combined with antiplatelet therapy in patients where concerns about bleeding risk prevail over concerns about stent thrombosis or ischemic stroke 1
- Dabigatran 110 mg twice daily may be considered in preference to dabigatran 150 mg twice daily when combined with antiplatelet therapy in patients where concerns about bleeding risk prevail over concerns about stent thrombosis or ischemic stroke 1
From the FDA Drug Label
The indications for XARELTO are not explicitly stated in the provided text.
The FDA drug label does not answer the question.
From the Research
Indications for Direct Oral Anticoagulants (DOACs)
The indications for DOACs include:
- Prevention of stroke in patients with atrial fibrillation 2, 3, 4, 5, 6
- Primary prevention, treatment, and secondary prevention of venous thromboembolic disease 3
- Prevention of stroke or systemic embolism in patients with nonvalvular atrial fibrillation 4, 5, 6
Specific DOACs and Their Indications
- Apixaban: prevention of stroke in patients with atrial fibrillation, treatment and secondary prevention of venous thromboembolic disease 2, 3, 5, 6
- Dabigatran: prevention of stroke in patients with atrial fibrillation, treatment and secondary prevention of venous thromboembolic disease 2, 3, 5, 6
- Edoxaban: prevention of stroke in patients with atrial fibrillation, treatment and secondary prevention of venous thromboembolic disease 2, 3
- Rivaroxaban: prevention of stroke in patients with atrial fibrillation, treatment and secondary prevention of venous thromboembolic disease 2, 3, 4, 5, 6
Key Findings
- DOACs have been shown to be effective in preventing stroke and systemic embolism in patients with atrial fibrillation, with a lower risk of major bleeding compared to warfarin 2, 3, 4, 5, 6
- The choice of DOAC depends on individual patient characteristics and the specific indication for use 2, 3, 4, 5, 6
- Head-to-head comparisons between different DOACs are limited, but available data suggest that apixaban and dabigatran may have a more favorable bleeding risk profile compared to rivaroxaban 5, 6