Direct oral anticoagulants (DOACs) are increasingly used for prevention and treatment of thromboembolism (TE). However, clinicians frequently encounter scenarios for which there is uncertainty about the optimal use of DOACs and management of complications. This session will address some of these challenges encountered during daily practice.
DOACs are currently approved for doses based on clinical trials for prophylaxis and therapeutic indications. However, there are clinical conditions that may benefit with lower doses for a variety of reasons. Dr. Beverly Hunt will address some of these conditions that might benefit with low dose DOACs.
Routine laboratory monitoring is not required for DOACs. However, with increased experience of DOACs use in real-world, there are some clinical scenarios where it might be useful to know (a). DOACs’ actual levels for their efficacy (e.g., occurrence of TE events on DOACs, extremes of body weights) or (b). rough estimate of DOAC presence in patients with major bleeding or requiring emergent surgery for guiding the use of specific reversal/non-specific hemostatic agents. Dr. Ravindra Sarode will cover laboratory testing for DOACs.
Although DOACs reduce the incidence of major bleeding, it remains the main complication of therapy. Specific reversal agents for DOACSs are available, however, their implementation and use can pose challenges for practicing clinicians. There are limited data on the use of non-specific hemostatic agents’ in this setting. Dr. Deborah Siegal will cover what we have learned about DOAC reversal and provide an approach to management of DOAC-related bleeding.
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