Related Experiment Video
Updated: Nov 29, 2025
The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation
Published on: February 28, 2012
Challenges of treatment adherence with direct oral anticoagulants in pandemic
Tolga Dittrich1, Alexandros Polymeris1, Gian Marco De Marchis1,2
1Department of Neurology and Stroke Center, University Hospital Basel.
Insights
Direct oral anticoagulants (DOACs) are vital for preventing blood clots in atrial fibrillation. This review covers DOAC use during COVID-19, addressing challenges like kidney issues and stroke management.
Area of Science:
- Cardiology
- Pharmacology
- Infectious Diseases
Background:
- Direct oral anticoagulants (DOACs) are essential for preventing thromboembolic events in nonvalvular atrial fibrillation.
- Suboptimal patient and physician adherence to DOAC guidelines exists.
- The COVID-19 pandemic introduced new considerations for anticoagulation therapy.
Purpose of the Study:
- To review direct oral anticoagulant (DOAC) treatment during the COVID-19 pandemic.
- To highlight challenges in DOAC therapy, including those exacerbated by the pandemic.
- To discuss specific clinical scenarios and guideline adherence.
Main Methods:
- Literature review focusing on DOACs, atrial fibrillation, and the COVID-19 pandemic.
- Analysis of interim clinical guidance for initiating oral anticoagulation.
- Discussion of challenges in DOAC dosing and contraindications.
Main Results:
- Interim guidance favors DOACs over vitamin K antagonists to minimize patient exposure during monitoring visits.
- Challenges in DOAC dosing for patients with kidney failure due to COVID-19 are discussed.
- Guidance on initiating DOACs post-ischemic stroke and the role of cerebral microbleeds is examined.
Conclusions:
- Despite advances, challenges in DOAC management persist for both patients and physicians, independent of and related to the pandemic.
- Adapting DOAC therapy to pandemic conditions and complex patient factors remains crucial.
- Further research and guideline refinement are needed to optimize DOAC use in challenging scenarios.
Purpose Of Review:
Direct oral anticoagulants (DOAC) are crucial for the prevention of thromboembolic events in patients with nonvalvular atrial fibrillation. Drug adherence by the patient but also adherence to guidelines by the physician are suboptimal. This review highlights aspects of DOAC treatment during the coronavirus disease 2019 (COVID-19) pandemic and selected challenging scenarios.
Recent Findings:
For patients with a newly diagnosed indication for oral anticoagulation, a new interim clinical guidance recommends starting DOAC instead of vitamin K antagonists if DOAC are not contraindicated. The goal is to reduce the potential exposure of patients to severe acute respiratory syndrome coronavirus during the routine coagulation monitoring visits. As COVID-19 can lead to kidney failure, we discuss the challenges of DOAC dosing in kidney failures. Finally, we discuss two common challenges - when to start a DOAC after an ischemic stroke linked to atrial fibrillation, and whether cerebral microbleeds, including their count, are per se a contraindication to DOAC.
Summary:
There are still open challenges regarding DOAC treatment on the patient and physician side, both related and unrelated to the pandemic.
Related Concept Videos
01:18Anticoagulant Drugs: Vitamin K Antagonists and Direct Oral Anticoagulants
Warfarin, a prominent vitamin K antagonist family member, exerts its effect by inhibiting the enzyme VKORC1 (vitamin K epoxide reductase complex 1). By hindering this enzyme, warfarin...
01:29Venous Thrombosis III: Interprofessional Care
01:30Anticoagulant Drugs: Low-Molecular-Weight Heparins
01:30Venous Thrombosis IV: Nursing Management
01:20Antiplatelet Drugs: Prostaglandin Synthesis, P2Y12 and Glycoprotein IIb/IIIa Inhibitors
Prostaglandin synthesis inhibitors, exemplified by the widely known aspirin, wield their power by irreversibly acetylating...
01:29Pulmonary Embolism II: Diagnostic Studies and Interprofessional Care