When Direct Oral Anticoagulants Should Not Be Standard Treatment

SCENARIOS IN WHICH DOACs HAVE DEMONSTRABLE EFFICACY AND SAFETY

1. stroke prevention in atrial fibrillation (SPAF)
2. atrial fibrillation and acute coronary syndromes or recent percutaneous coronary intervention(the ideal regimen for stable patients who have undergone percutaneous intervention or had a recent acute coronary syndrome and have atrial fibrillation is a DOAC with a single antiplatelet agent, preferably a P2Y12 inhibitor, for which clopidogrel is typically chosen)
3. In patients with atrial fibrillation with many types of valvular heart disease, DOACs are currently recommended
4. For patients with VTE, guidelines recommend the use of DOACs for acute management,including for cancer-associated thrombosis, as well as extendedduration secondary prevention of VTE
5. In patients with stable atherosclerotic cardiovascular disease or after recent peripheral artery revascularization, low-intensity rivaroxaban was shown to play a role in the reduction of cardiovascular events in combination with aspirin.
   
   

SCENARIOS WHERE DOACs ARE LESS EFFICACIOUS OR SAFE, OR PROVIDE NO BENEFIT COMPARED WITH STANDARD OF CARE

1. Mechanical heart valves
2. Rheumatic atrial fibrillation
3. THROMBOTIC ANTIPHOSPHOLIPID SYNDROME
4. TRANSCATHETER AORTIC VALVE REPLACEMENT.
5. EMBOLIC STROKE OF UNDETERMINED SOURCE
6. LEFT VENTRICULAR ASSIST DEVICE
7. HEART FAILURE WITH REDUCED LEFT VENTRICULAR SYSTOLIC FUNCTION WITHOUT AF