#6-27E. Beyond Standard Care: When to Avoid Direct Oral Anticoagulants (JACC, 2024)

While direct oral anticoagulants are the preferred standard for stroke prevention and thromboembolism treatment, when should clinicians avoid their use? This review highlights that direct oral anticoagulants fail to show efficacy or safety in mechanical valves, rheumatic atrial fibrillation, and antiphospholipid syndrome, while offering no benefit in embolic stroke of undetermined source. Crucially, as an evidence synthesis rather than a formal guideline, several underlying trials suffered from small sample sizes or early termination. Recognizing these evidence boundaries prevents inappropriate prescribing and optimizes patient safety in daily practice.

Citation: Antoine Bejjani, Candrika D. Khairani, Behnood Bikdeli, et al. When Direct Oral Anticoagulants Should Not Be Standard Treatment. Journal of the American College of Cardiology. 2024.

DOI: 10.1016/j.jacc.2023.10.038

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