PT  - JOURNAL ARTICLE
AU  - Geoffrey D Barnes
AU  - Brian Kurtz
TI  - Direct oral anticoagulants: unique properties and practical approaches to management
AID  - 10.1136/heartjnl-2015-309075
DP  - 2016 Oct 15
TA  - Heart
PG  - 1620--1626
VI  - 102
IP  - 20
4099  - http://heart.bmj.com/content/102/20/1620.short
4100  - http://heart.bmj.com/content/102/20/1620.full
SO  - Heart2016 Oct 15; 102
AB  - Since 2009, four direct oral anticoagulants (DOACs) have been introduced for treatment of venous thromboembolism and stroke prevention in non-valvular atrial fibrillation. While they are currently first-line therapy for a majority of patients, there are a number of clinical situations where warfarin is preferable. In both randomised trials and real-world populations, use of DOACs significantly reduces the risk of intracranial haemorrhage as compared with warfarin. While drug-specific reversal agents are currently only available for dabigatran, andexanet alpha is pending approval for reversal of factor Xa inhibitors, reducing concerns about major bleeding for many patients and providers. DOACs can be held for 2–4 days prior to a procedure, depending on a patient’s renal function, but should not be restarted too rapidly post-procedurally given their fast time to peak activity (∼2 hours). The anticoagulation clinic should play an important role in managing patients on all oral anticoagulation, both warfarin and DOACs.