Commentary: Increasing Clinician Awareness of Target-Specific Oral Anticoagulants

Target-specific oral anticoagulants have been approved by the U.S. Food and Drug Administration for only two to three years, so many clinicians may be unfamiliar with their use and properties, states the author of a commentary from the December 2013 edition of the Agency for Healthcare Research and Quality’s (AHRQ) online case study review, WebM&M. In the spotlight case, a 39-year-old woman with a history of deep-vein thrombosis who underwent an uncomplicated knee replacement received an epidural catheter to control her pain after the procedure. Because anticoagulants are contraindicated at the time of insertion or removal of an epidural due to bleeding risk, the patient’s oral anticoagulant, rivaroxaban, was discontinued preprocedure, and she was given an injection of enoxaparin postprocedure as a "bridge" until she could resume her oral anticoagulant. Her outpatient dose of rivaroxaban was started again on the second hospital day. When a clinician came to remove her epidural catheter, he scanned the medication list to be sure the patient was not on enoxaparin or warfarin or other traditional anticoagulants but failed to recognize rivaroxaban as such.