Nonvalvular atrial fibrillation- (NVAF-) related stroke and venous thromboembolism (VTE) are cardiovascular diseases associated\nwith significant morbidity and economic burden. The historical standard treatment of VTE has been the administration of\nparenteral heparinoid until oral warfarin therapy attains a therapeutic international normalized ratio. Warfarin has been the\nmost common medication for stroke prevention in NVAF. Warfarin use is complicated by a narrow therapeutic window,\nunpredictable dose response, numerous food and drug interactions, and requirements for frequent monitoring. To overcome\nthese disadvantages, direct-acting oral anticoagulants (DOACs)ââ?¬â?dabigatran, rivaroxaban, apixaban, and edoxabanââ?¬â?have been\ndeveloped for the prevention of stroke or systemic embolic events (SEE) in patients with NVAF and for the treatment of VTE.\nAdvantages of DOACs include predictable pharmacokinetics, few drug-drug interactions, and low monitoring requirements. In\nclinical studies, DOACs are noninferior to warfarin for the prevention of NVAF-related stroke and the treatment and prevention\nof VTE as well as postoperative knee and hip surgery VTE prophylaxis, with decreased bleeding risks. This review addresses the\npractical considerations for the emergency physician in DOAC use, including dosing recommendations, laboratory monitoring,\nanticoagulation reversal, and cost-effectiveness. The challenges of DOACs, such as the lack of specific laboratory measurements\nand antidotes, are also discussed
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