Direct-Acting Oral Anticoagulant Do's and Don'ts

Cardiologist Robert D. McBane, M.D., and Ariela L. Marshall, M.D., with Hematology at Mayo Clinic's campus in Rochester, Minnesota, discuss the new U.S. Food & Drug Administration drug watch list — and specifically, direct-acting oral anticoagulants (DOACs).

DOACs are a class of drugs that, although different in their action, are clinically similar. DOACs can be used for stroke prevention in nonvalvular atrial fibrillation, treatment of venous thromboembolic disease such as deep venous thrombosis or pulmonary embolism, and clot prevention after orthopedic surgery such as a hip or knee replacement, as well as many other conditions.

Benefits of DOACs:

  • Reduction of major bleeding
  • Do not need to be directly monitored
  • Tend to not interact with other medications
  • Less painful and easier to use than other medications such as heparin
  • Generally less expensive
  • Fully therapeutic within 1 to 3 hours of taking them, making them an attractive medication after major surgeries

Patients who are not good candidates for DOACs include those with mechanical hearts or antiphospholipid antibody syndrome, or patients who are pregnant. 

Video Content Outline:

  • Introduction
  • Defining DOACs(0:30)
  • What are they used for
  • FDA approved indications
  • Defining differences among DOACs (2:13)
  • DOACs vs Warfarin (4:50)
  • Reversing bleeding in DOACs (7:50)
  • Candidates for DOACs and the importance of compliance (11:14)
  • Conclusion (18:08)

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