NOAC Use within DOC’s Institutions

The use of warfarin is still the preferred pharmaceutical to use in anticoagulation; however the agency recognizes that there are instances where NOACs (Non-vitamin K antagonist oral anticoagulants) may be prescribed and utilized within our environment.

Patients that enter our institutions that are currently on a NOAC will be transitioned to warfarin treatment in the following manner:

• Patient will continue to receive their NOAC with warfarin for at least two days.
• An INR will be obtained after the two days, but just prior to the next scheduled dose of NOAC.
• Continue co-administration of NOAC and warfarin until INR is ≥2.0. For the purposes of this transition, INR can be drawn every 3-5 days.
• Once INR is ≥2.0, discontinue NOAC.

Patients may return from a procedure with an order for NOAC treatment. DOC recognizes that NOACs have FDA approval for use in prophylaxis of deep vein thrombosis (DVT) for arthroplasty of knee and hip repair.  Patients returning into our institutions with these conditions for a NOAC will be granted approval for a duration of 12 days for arthroplasy of knee and 35 days for hip repair.  Longer durations of use will require TLOC approval.

Please note, NOAC medications will not be allowed in cell, and must be administered at medline.