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When Direct Oral Anticoagulants Should Not Be Standard Treatment: JACC State-of-the-Art Review (JACC January 2024-2)
For most patients, direct oral anticoagulants (DOACs) are preferred over vitamin-K antagonists for stroke prevention in atrial fibrillation and for venous thromboembolism treatment. However, randomized controlled trials (RCTs) suggest that DOACs may not be as efficacious or as safe as the standard of care in conditions such as mechanical heart valves, thrombotic antiphospholipid syndrome, and atrial fibrillation associated with rheumatic heart disease. DOACs do not provide a net benefit in conditions such as embolic stroke of undetermined source. Their efficacy is uncertain for conditions such as left ventricular thrombus, catheter-associated deep vein thrombosis, cerebral venous sinus thrombosis, and for patients with atrial fibrillation or venous thrombosis who have end-stage renal disease. This manuscript provides an evidence-based review of RCTs on DOACs, detailing when they have demonstrated efficacy and safety, when DOACs should not be the standard of care, where their safety and efficacy are uncertain, and areas requiring further research.

Valentin Fuster, MD, PhD, MACC

CME Editor
Ragavendra R. Baliga, MD

Barbara S. Wiggins, PharmD, FACC 

Important Dates
Date of Release: January 15, 2024

Term of Approval/Date of CME/MOC Expiration: January 14, 2025
Availability: On-Demand
Expires on Jan 14, 2025
Cost: FREE
Credit Offered:
1 CME Credit
1 ABIM-MOC Point
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