Direct Oral Anticoagulants (DOAC): Challenges and Decisions Live

I. Introduction

II. Evolution of Anticoagulants

III. Thrombotic Disorders

IV. Classes of Direct Oral Anticoagulants

A. Direct Thrombin Inhibitors
B. Factor Xa Inhibitors

V. Discussion

A. Indication Similarities
B. Agent Selection and Ongoing Management
C. DOAC Monitoring Challenges and Special Populations
D. Drug Interactions
E. Future Research

VI. Interruption and Peri-Procedural Management

A. Drug Interactions
B. Reversal Agents

VII. Future Research

VIII. Clinical Pearls for Patient and Prescriber Discussions

IX. Summary

Faculty Planner Disclosure

The following individuals were involved in planning, developing, and/or authoring this activity: L. Austin Fredrickson, MD, FACP; Kimberly Valenta, MD; Kristina (Tia) Neu, RN; and Pamela Sardo, PharmD, BS. None of the individuals involved in developing this activity has a conflict of interest or financial relationships related to the subject matter. There are no financial relationships or commercial or financial support relevant to this activity to report or disclose by RxCe.com or any of the individuals involved in the development of this activity.

Unlabeled Use Disclosure

The information provided in this course is general in nature, and it is designed solely to provide participants with continuing education credit(s). This course and materials are not meant to substitute for the independent, professional judgment of any participant regarding that participant’s professional practice, including but not limited to patient assessment, diagnosis, treatment, and/or health management. Medical and pharmacy practices, rules, and laws vary from state to state, and this course does not cover the laws of each state; therefore, participants must consult the laws of their state as they relate to their professional practice. Healthcare professionals must consult their employer, healthcare facility, hospital, or other organization for guidelines, protocols, and procedures to follow. The information provided in this course does not replace those guidelines, protocols, and procedures, but is for academic purposes only, and this course’s limited purpose is for the completion of continuing education credits. Participants are advised and acknowledge that information related to medications, their administration, dosing, contraindications, adverse reactions, interactions, warnings, precautions, or accepted uses is constantly changing. Any person taking this course understands that such a person must make an independent review of medication information before any patient assessment, diagnosis, treatment and/or health management. Any discussion of off-label use of any medication, device, or procedure is informational only, and such uses are not endorsed hereby. Nothing contained in this course represents the opinions, views, judgments, or conclusions of RxCe.com LLC. RxCe.com LLC is not liable or responsible to any person for any inaccuracy, error, or omission with respect to this course or course material.

Statement of Need

Thrombotic disorders place a substantial burden on patients and the healthcare system, contributing to significant morbidity and mortality worldwide. Anticoagulant therapy plays a central role in the prevention and treatment of thromboembolic disease. There are potential knowledge and application gaps regarding the selection of anticoagulation options and the identification of situations in which direct oral anticoagulant (DOAC) therapy may be appropriate or require modification. This activity is intended to address this gap by providing knowledge of the indications and dosing for various DOAC agents, as well as when they may be inappropriate or require modification.

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