Topic overview

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DOACs act through reversible, direct inhibition of thrombin or factor Xa. Their rapid onset, relatively short half-lives, and predictable pharmacokinetics allow fixed dosing without routine INR monitoring or parenteral bridging. The topic covers their roles in stroke prevention for non-valvular atrial fibrillation, treatment and secondary prevention of DVT and PE, and VTE prophylaxis after hip or knee arthroplasty. It also highlights important limitations, including bleeding risks, drug interactions, renal considerations, and contraindications such as mechanical heart valves. Reversal options and specialized monitoring tests are introduced, alongside practical points on dosing and stopping treatment before surgery. These concepts provide a framework for comparing DOACs with warfarin and recognizing situations that require added caution.