Direct oral anticoagulants and cases when they are not preferred

Artūras Smirnovas1, Rūta Palionytė1 

1Viešoji įstaiga Respublikinė Šiaulių ligoninė


After introduction, direct oral anticoagulants (DOAKs) instantly became well promising alternative to warfarin with their advantages: lower bleeding risk, fewer interactions with other medications, simplified usage – patients aren’t required to perform constantly blood sampling to check an INR (international normalized ratio). In most cases DOAKs show better therapeutic results and are way safer than warfarin. That’s why they became great instrument in thromboembolism treatment and stroke prevention. Despite all the advantages DOAKs have, they can’t be used in several certain situations or when medications need to be precisely dosed. In those situations warfarin or other anticoagulants are preferred. DOAKs are contraindicated for patients with mechanical heart valves and those patients are forced to use warfarin. DOAKs aren’t recommended during the pregnancy because of possible increased miscarriage risk and possible fetus defects. There aren’t enough of information about the DOAKs usage in patients with antiphospholipid syndrome group. The more impaired renal function is, the less DOAKs is appealing against vitamin K antagonists. Patients with hepatic impaired should take warfarin instead of DOAKs, because of the better monitoring possibilities and easily reachable antidote (vitamin K). It is very important that physicians could handle DOAKs induced bleeding, especially intestinal bleeding and would be always prepared to cope with all DOAKs’ complications. Because of higher risk of bleeding, elderly patients should use lower doses of DOAKs.

Keywords: DOAKs, direct oral anticoagulants, contraindications, DOAKs disadvantages