Direct Oral Anticoagulants (DOACs): Challenges and Decisions
Target Audience: Pharmacist, Pharmacy Tech, Physician Assistant, Physician
Course Overview
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, yet its use requires careful clinical judgment given the competing risks of thrombosis and bleeding. Within interdisciplinary care teams, healthcare professionals collaborate to evaluate anticoagulation options and identify situations in which DOAC therapy is indicated, inappropriate, or requires modification. A shared understanding of the similarities and differences among DOAC agents is essential for optimizing therapy, reducing preventable adverse events, supporting safe transitions of care, and supporting informed discussions with patients and other members of the healthcare team.
Learning Objectives
Upon completion of this educational activity, participants should be able to:
- Identify the indications and dosing for various direct oral anticoagulant (DOAC) agents
- Identify the contraindications and potential side effects within the DOAC class
- Apply this information to answer patient or prescriber questions
Faculty
Maintenance of Certification (MOC): Continuing Certification is offered for the American Board of Internal Medicine® (ABIM) and the American Board of Pediatrics® (ABP).
Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 2.0 Medical Knowledge MOC points. Participants will earn MOC points equivalent to the amount of CME credits claimed for the activity. It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.
Successful completion of this CME activity, which includes participation in the evaluation component and post-test, qualifies for MOC points with the following boards:
American Board of Internal Medicine (ABIM)
- Cardiology
- Critical Care
- Geriatrics & Palliative Care
- Hematology
- Hospital Medicine
- Internal Medicine
- Introduction
- Evolution of Anticoagulants
- Thrombotic Disorders
- Classes of Direct Oral Anticoagulants
- Direct Thrombin Inhibitors
- Factor Xa Inhibitors
- Discussion
- Indication Similarities
- Agent Selection and Ongoing Management
- DOAC Monitoring Challenges and Special Populations
- Drug Interactions
- Future Research
- Interruption and Peri-Procedural Management
- Drug Interactions
- Reversal Agents
- Future Research
- Clinical Pearls for Patient and Prescriber Discussions
- Summary
From March 13, 2026 through March 13, 2029, participants must:
- Read the "learning objectives" and "author and planning team disclosures"
- Study the section entitled "educational activity"
- Complete the Course Test and Evaluation form. The Course Test will be graded automatically. Following successful completion of the Course Test with a score of 70% or higher, a statement of participation will be made available immediately. (No partial credit will be given.)
Credit for this course will be automatically uploaded to JA_PARS.
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.
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Accreditation
In support of improving patient care, RxCE.com is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.