Anticoagulants (DOACs)
- Oral anticoagulants without routine INR
- AF stroke prevention + VTE treatment
- Apixaban/rivaroxaban/edoxaban inhibit Xa
- Dabigatran directly inhibits thrombin
- Fast onset; renal function matters
- Fewer food interactions than warfarin
- Major bleeding; adherence is crucial
- Avoid for mechanical heart valves
Class at a glance
- Oral anticoagulants without routine INR
Pharmacology
- Apixaban/rivaroxaban/edoxaban inhibit Xa
- Dabigatran directly inhibits thrombin
Clinical role
- AF stroke prevention + VTE treatment
- Fewer food interactions than warfarin
Safety / monitoring
- Fast onset; renal function matters
- Major bleeding; adherence is crucial
- Avoid for mechanical heart valves
Pearls
- Short t½: missed doses quickly raise clot risk
- About half the intracranial bleeding of warfarin
- Avoid in pregnancy, breastfeeding, severe hepatic impairment
- No large head-to-head comparisons among DOACs
- Sparse data in elderly, renal impairment, very low weight
Self-check
- Which DOAC directly inhibits thrombin?
Dabigatran. - Which valve setting should DOACs be avoided in?
Mechanical heart valves.
Drugs in this class (4)
Anticoagulants (DOACs) prescription history
Animated chart of estimated U.S. prescriptions per year, Antithrombotics (1914–2026). Direct anticoagulants highlighted from 2011.
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