Direct oral anticoagulant use: A practical guide to common clinical challenges

Ashley Chen, Eric Stecker, Bruce A. Warden

Research output: Contribution to journalArticlepeer-review

252 Scopus citations


Direct oral anticoagulants (DOACs) have quickly become attractive alternatives to the long-standing standard of care in anticoagulation, vitamin K antagonist. DOACs are indicated for prevention and treatment of several cardiovascular conditions. Since the first approval in 2010, DOACs have emerged as leading therapeutic alternatives that provide both clinicians and patients with more effective, safe, and convenient treatment options in thromboembolic settings. With the expanding role of DOACs, clinicians are faced with increasingly complex decisions relating to appropriate agent, duration of treatment, and use in special populations. This review will provide an overview of DOACs and act as a practical reference for clinicians to optimize DOAC use among common challenging scenarios. Topics addressed include (1) appropriate indications; (2) use in patients with specific comorbidities; (3) monitoring parameters; (4) transitioning between anticoagulant regimens; (5) major drug interactions; and (6) cost considerations.

Original languageEnglish (US)
Article numbere017559
JournalJournal of the American Heart Association
Issue number13
StatePublished - Jul 7 2020


  • Anticoagulation
  • Oral direct thrombin inhibitor
  • Oral factor Xa inhibitors
  • Pharmacotherapy

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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