Direct oral anticoagulants: Challenging prescribing scenarios in everyday practice.

Direct oral anticoagulants (DOACs) are preferred to vitamin K antagonists for treating venous thromboembolism and nonvalvular atrial fibrillation, primarily because of comparable efficacy, consistent dosing, and fewer drug-drug interactions. However, major trials that led to the approval of DOACs excluded subsets of patients who are challenging to treat in the primary care setting, including patients with extreme body weight, advanced kidney disease, and advanced cirrhosis, and those who have undergone bariatric surgery. The authors review the available evidence and outline current recommendations to help guide the appropriate use of DOACs in these patients.