Direct Oral Anticoagulants (DOACs) are a simple, effective way to prevent strokes in atrial fibrillation (AF) and treat deep vein thrombosis (DVT) and pulmonary embolism (PE). They work just as well as warfarin but come with fewer food and drug interactions and no need for regular INR monitoring.
DOACs in Atrial Fibrillation (AF)
Why Are DOACs Used in AF?
DOACs help prevent blood clots and strokes in people with non-valvular AF by keeping the blood flowing smoothly. They’re a popular choice because they:
✔ Lower stroke risk without the hassle of frequent blood tests
✔ Have fewer interactions with food and medications than warfarin
✔ Provide predictable blood thinning, meaning more stable protection
Who Should Take a DOAC?
Doctors often recommend DOACs if you have:
✔ A CHA₂DS₂-VASc score of 2 or more (men) or 3 or more (women)
✔ A history of stroke, TIA (mini-stroke), or other embolism
✔ A higher risk of clot formation due to conditions like high blood pressure, diabetes, or heart failure
DOACs in AF – Simple Dosing Guide
| DOAC | Standard Dose | Reduced Dose (If Needed) | When to Reduce? |
|---|---|---|---|
| Apixaban | 5 mg twice daily | 2.5 mg twice daily | If 2 or more of: age ≥80, weight ≤60kg, creatinine ≥133µmol/L |
| Rivaroxaban | 20 mg once daily (with food) | 15 mg once daily (with food) | If eGFR 15-49 mL/min |
| Dabigatran | 150 mg twice daily | 110 mg twice daily | If age ≥80 or high bleeding risk |
| Edoxaban | 60 mg once daily | 30 mg once daily | If eGFR 15-50, weight ≤60kg, or taking certain P-gp inhibitors |
🔹 Tip: Taking DOACs at the same time each day helps ensure steady protection!
DOACs in Deep Vein Thrombosis (DVT) & Pulmonary Embolism (PE)
DOACs are also first-line treatments for DVT and PE. They help dissolve existing clots and prevent new ones from forming, reducing the risk of complications like another clot or lung damage.
When Are DOACs Used for DVT/PE?
✔ Treating a first DVT or PE
✔ Preventing clots from coming back
✔ Reducing risk of blood clots after major surgery (e.g., hip or knee replacement)
DOACs in DVT/PE – Simple Dosing Guide
| DOAC | Initial Treatment Dose | Long-term/Prevention Dose |
|---|---|---|
| Apixaban | 10 mg twice daily for 7 days, then 5 mg twice daily | 2.5 mg twice daily (if long-term prevention is needed) |
| Rivaroxaban | 15 mg twice daily for 21 days, then 20 mg once daily | 10 mg once daily (if long-term prevention is needed) |
| Dabigatran | Requires 5 days of injectable heparin first, then 150 mg twice daily | 150 mg twice daily |
| Edoxaban | Requires 5 days of injectable heparin first, then 60 mg once daily | 30 mg once daily (if eGFR 15-50, weight ≤60kg) |
🔹 Tip: Unlike Dabigatran and Edoxaban, which require a 5-day course of injectable heparin before starting, Apixaban and Rivaroxaban can be started right away with no injections needed!
When Should DOACs Be Avoided?
While DOACs are a great option for many, they aren’t suitable for everyone. Your doctor may recommend a different blood thinner if you have:
✔ A mechanical heart valve (warfarin is preferred)
✔ Moderate to severe mitral stenosis
✔ Severe kidney disease (eGFR <15 mL/min)
✔ Liver disease that affects clotting
✔ Active bleeding or a high bleeding risk
✔ Pregnancy or breastfeeding (DOACs are not recommended)
Other Important Considerations
✔ Kidney function matters – Your doctor may check your kidney health to ensure you’re on the right dose.
✔ Bleeding risk – Avoid combining DOACs with aspirin, NSAIDs, or certain antidepressants (SSRIs) unless advised by your doctor.
✔ Surgery & procedures – You might need to pause your DOAC before major surgery—always check with your doctor!
✔ Missed a dose? – Take it as soon as you remember, but don’t double up if you’ve already missed a full day.
DOACs have made life simpler, safer, and more convenient for people needing anticoagulation. If you have any questions, your doctor or pharmacist is always the best person to guide you!
