Direct Oral Anticoagulants in Special Patient Populations

Asa Kessler, Yotam Kolben, Gal Puris, Martin Ellis, Mordechai Alperin, Vered Simovich, Hila Lerman Shivek, Mordechai Muszkat, Yoram Maaravi, Yitschak Biton*

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

1 Scopus citations


Anticoagulants are a cornerstone of treatment in atrial fibrillation. Nowadays, direct oral anticoagulants (DOACs) are extensively used for this condition in developed countries. However, DOAC treatment may be inappropriate in certain patient populations, such as: patients with chronic kidney disease in whom DOAC concentrations may be dangerously elevated; frail elderly patients with an increased risk of falls; patients with significant drug–drug interactions (DDI) affecting either DOAC concentration or effect; patients at the extremes of body mass in whom an “abnormal” volume of distribution may result in inappropriate drug concentrations; patients with recurrent stroke reflecting an unusually high thromboembolic tendency; and, lastly, patients who experience major hemorrhage on an anticoagulant and in whom continued anticoagulation is deemed necessary. Herein we provide a fictional case-based approach to review the recommendations for the use of DOACs in these special patient populations.

Original languageAmerican English
Article number216
JournalJournal of Clinical Medicine
Issue number1
StatePublished - 29 Dec 2023

Bibliographical note

Publisher Copyright:
© 2023 by the authors.


  • atrial fibrillation
  • direct oral anticoagulants
  • special populations


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