For more than 50 years, vitamin K antagonists (VKAs) such as warfarin were the only oral anticoagulant options for patients with blood clotting disorders. In 2010, dabigatran (Pradaxa®) – a direct thrombin inhibitor – became the first approved agent from the next generation of oral anticoagulants. Over the next 7 years, 4 factor Xa inhibitor oral anticoagulants were FDA approved. These include rivaroxaban (Xarelto®), apixaban (Eliquis®), edoxaban (Savaysa™), and most recently, betrixaban (Bevyxxa®). Early on, this generation of oral anticoagulants was referred to as NOACs (Novel Oral AntiCoagulants). However, the Institute For Safe Medication Practices (ISMP) issued a safety alert because “NoAC” was interpreted as “no anticoagulation” in a patient at high risk of stroke. The ISMP designated “NoAC” a potentially dangerous abbreviation and discourages its use. Today, the acronym DOAC, for Direct-acting Oral AntiCoagulant, is the abbreviation most widely used to distinguish these medications from warfarin.
The “Oath of a Pharmacist” that is recited at pharmacy school graduations emphasizes the importance of medication safety in the profession. The passage says, “I