Kerstin De Witt (nee Hogg) is an Emergency Physician and Thrombosis Physician and Researcher in Canada
We talk about the use of DOACs in VTE and potential reversal agents
When thinking of starting a DOAC, checking the creatinine clearance is really important. If it is <25mm, then it’s probably not advised. Recent bleeding would need thinking about. Also think about interacting medications – especially anticonvulsants where alternative anticoagulants are normally available. Cancer patients should probably be on low molecular weight heparin – we know for sure LMWH is better than warfarin, but we don’t know about the DOACs yet. We should also avoid them in pregnancy, and breastfeeding patients.
Reversal of DOACs is interesting – and they are known to cause bleeding, especially GI. In patients bleeding on dabigatran, we have idarucizumab
Kerstin De Witt, Andy Neil