Journal article
2025 Guidelines for direct oral anticoagulants: a practical guidance on the prescription, laboratory testing, peri‐operative and bleeding management
Internal medicine journal, Vol.55(7), pp.1174-1183
2025
PMID: 40448969
Abstract
Direct oral anticoagulants (DOACs) are widely prescribed to prevent and treat venous and arterial thromboembolism, supported by published evidence, and are preferred over warfarin in many guidelines. Although the risk of major bleeding, in particular intracranial haemorrhage (ICH), is decreased with DOACs, gastrointestinal bleeding is increased with some DOACs, and the case fatality rate of bleeding remains high. Therefore, it is important to (i) prescribe DOACs appropriately, (ii) have strategies to manage major bleeding including the use of specific reversal agents and (iii) interrupt and resume DOACs for procedures. The main recommendations are as follows: (i) Select the appropriate dose of DOAC according to indications and consider patient factors to minimise bleeding risks; (ii) DOACs do not require routine laboratory testing; (iii) for life‐threatening uncontrollable bleeding, specific agents can be used to reverse the anticoagulant effects of DOACs; and (iv) DOACs can be interrupted for planned procedures without the need for ‘bridging’ with low‐molecular‐weight heparin (LMWH). The anticoagulant effects of DOACs can be reversed with specific agents, such as andexanet for apixaban and rivaroxaban and idarucizumab for dabigatran. If not available, pro‐haemostatic agents such as prothrombin complex concentrates or activated prothrombin complex concentrates can be considered. DOACs can be interrupted and resumed for procedures without the need for ‘bridging’ with LMWH.
Details
- Title
- 2025 Guidelines for direct oral anticoagulants: a practical guidance on the prescription, laboratory testing, peri‐operative and bleeding management
- Authors/Creators
- Huyen A. Tran - The Alfred HospitalEileen Merriman - North Shore HospitalRoss Baker - Queensland Department of the Premier and CabinetJennifer Curnow - Westmead HospitalLaura Young - Auckland City HospitalChee Wee Tan - Royal Adelaide HospitalSimon McRae - Launceston General HospitalSanjeev D. Chunilal - Monash Medical Centre
- Publication Details
- Internal medicine journal, Vol.55(7), pp.1174-1183
- Publisher
- John Wiley & Sons Australia, Ltd
- Number of pages
- 10
- Identifiers
- 991005883837707891
- Copyright
- © 2025 The Author(s)
- Murdoch Affiliation
- Centre for Molecular Medicine and Innovative Therapeutics
- Language
- English
- Resource Type
- Journal article
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- Collaboration types
- Domestic collaboration
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- Citation topics
- 1 Clinical & Life Sciences
- 1.94 Cardiac Arrhythmia
- 1.94.95 Atrial Fibrillation Management
- Web Of Science research areas
- Hematology
- ESI research areas
- Clinical Medicine