Are there still clinical situations in which you deliberately treat patients with a DOAC besides apixaban?

Thank you for your question. Apixaban has been my preferred agent for a long time for patients requiring therapeutic anticoagulation.

Apixaban’s lower bleeding risk was shown prior to and now has additional evidence to support this with the COBRRA trial. The risk is also ameliorated by the safety in...

Unfortunately, some of my patients can not afford any of the name-brand DOAC meds, so my backup solution is to order generics.

Dabigatran from a pharmacy like Mark Cuban Cost Plus, which charges only $23.80 for a month's supply.

Another potential issue is drug-drug interaction. Both Apixaban and Rivaroxaban are metabolized via CYP3A4. Patients on drugs like Apalutamide and Enzalutamide (which can reduce the efficacy of Apixaban and Rivaroxaban) should probably receive Edoxaban, Dabigatran, or a traditional anticoagulant.

I almost exclusively use apixaban unless there is some issue with compliance on a BID regimen or insurance coverage.

Apixaban Indications

• Afib/Aflutter (5 mg BID)
• HIT
• LV thrombosis, treatment or prophylaxis
• VTE treatment (10 mg BID >5 mg BID)
• VTE prophylaxis (2.5 mg BID)

Rivaroxaban Indications

• Afib/Aflutter (20 mg with dinner)
• HIT
• LV thrombosis, treatment or prophylaxis
• VTE treatment (15 mg BID >20 QD)
• VTE prophy...

The site of absorption is another potential consideration.

For patients with colectomy or extensive small bowel removal, I choose rivaroxaban over apixaban due to the majority of its absorption being more proximal.