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🎙️ Episode 42: DOACs Decoded: When to Dabble, When to Dodge
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🧠 Clinical Context
DOACs (Direct Oral Anticoagulants) have revolutionized anticoagulation—goodbye routine INRs, hello convenience. But while they’ve made our lives easier, they’re not always a fit for every scenario. Here's how to navigate the DOAC jungle.
✅ When DOACs Are Preferred
- Venous Thromboembolism (VTE)
- Atrial Fibrillation
- ⚠️ Exclude patients with:
- Mechanical heart valves
- Rheumatic mitral valve disease
(That’s why cardiologists note “non-rheumatic” AF in their documentation—treatment plan hinges on it.)
- ⚠️ Exclude patients with:
⛔ When DOACs Are a No-Go
- Mechanical Heart Valves → Warfarin only
- Rheumatic AF → Warfarin still rules
- Thrombotic Antiphospholipid Syndrome → Warfarin
- Transcatheter Aortic Valve Replacement (TAVR) → Antiplatelet therapy
- Embolic Stroke of Undetermined Source → Antiplatelets preferred
🤔 The Gray Zone: Uncertain Use Cases
These aren’t absolute yes or no. Instead, cue shared decision-making and expert input:
- Pregnancy
- No strong evidence yet; avoid unless discussed with OB and hematology.
- End-Stage Renal Disease (ESRD)
- Initially excluded from DOAC trials.
- Some are doing well, but still a case-by-case basis.
- Others That Require Discussion:
- Left Ventricular Thrombus
- Catheter-Associated DVT
- Splanchnic Vein Thrombosis
- Cerebral Venous Thrombosis
🧩 Clinical Takeaway
DOACs are game-changers—but they’re not plug-and-play for everyone. For classic AF and VTE? Go for it. For valves, rheumatic disease, or complex syndromes? Tread carefully. And when in doubt, involve the patient in the decision.
🎯 Bottom line: Not every clot deserves a DOAC—some still want warfarin or a platelet plan.
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Chapters
1. 🎙️ Episode 42: DOACs Decoded: When to Dabble, When to Dodge (00:00:00)
2. DOACs: Revolutionary Blood Thinners (00:00:20)
3. When DOACs Are Preferred (00:00:54)
4. Clear DOAC Contraindications (00:01:20)
5. Uncertain Cases Requiring Shared Decision-Making (00:02:13)
45 episodes
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