Novel oral anticoagulants (NOACs)

These include rivaroxaban and apixaban, which are direct inhibitors of factor Xa. NOACs are becoming popular choices to treat DVT as they have several advantages over warfarin; fewer drug interactions (leading to a more predictable anticoagulant effect) and no need for regular blood tests for monitoring. Treatment regimes approved by NICE include:

Rivaroxban – 15 mg twice daily for the first 21 days followed by 20 mg once daily.

Apixaban 10mg twice daily for the first 7 days, followed by 5mg twice daily.

If neither rivaroxaban nor apixaban are deemed suitable, an alternative regime may be LMWH for 5 days followed by dabigatran or edoxaban.

For further guidance on treatment options in those with renal impairment, active cancer or antiphospholipid syndrome, consult the most recent NICE guidelines.⁴