Medicines

You say NOAC and I say DOAC


The ageing of ‘novel’ or ‘new’ anticoagulants (NOACs) and the imprecise description of the class has prompted calls for a new name – and the likely contender is DOACs.

‘Direct oral anticoagulants’ was the winner when a subcommittee of the International Society on Thrombosis and Haemostasis surveyed the leaders of thrombosis, haemostasis, anticoagulation and vascular medicine societies in Europe and North America.

An alternative version of NOAC – ‘non-VKA oral antagonists’ – was suggested by some respondents but rejected on the basis that “identifying a class of drugs by what they are not is scientifically unappealing”.

The alphabet soup of potential alternatives also included ODIs, SODAs and TSOACs. To the uninitiated, these are oral direct inhibitors, specific oral direct anticoagulants, and target specific oral anticoagulants.

There were several concerns about the NOAC nomenclature, the subcommittee said.

Writing in the Journal of Thrombosis and Haemostasis, its representatives said that NOACs were “not so new or novel any more”. There were also some safety concerns, as there were cases of ‘NOAC’ in drug charts being interpreted as ‘no anticoagulation”.

NOACs/DOACs include dabigatran (a direct inhibitor of thrombin or Factor IIa) and rivaroxaban, apixaban, edoxaban and betrixaban (direct inhibitors of Factor Xa).

“Use of the term ‘direct’ adequately distinguishes this class of medications from the VKAs, and allows each of these medications to be discussed on the basis of their similar (but not exactly the same) clinical profiles,” they said.

“Given the potential safety limitations associated with the use of NOAC and the relative specificity of pharmacologic action, DOAC is a reasonable choice. DOAC is also used widely in the published literature, making it a very reasonable selection.”

The subcommittee formally recommended:

  • using the term DOAC to reference the class of oral anticoagulants that directly inhibit a single target and have similar clinical properties
  • describing the drug’s specific mechanism of action (eg direct FXa inhibitor or direct  thrombin inhibitor) when it is clinically important to distinguish between the various DOAC medications

The recommendation has been endorsed by a number of influential North American and European professional and scientific societies.

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