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MCPHS University

Use and Reversal of Direct Acting Oral Anticoagulants in Complicated Patients

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Overview / Abstract:

The approval of 5 direct acting oral anticoagulants (DOACs) in the past 8 years has changed the treatment and prevention of venous thromboembolism and cerebral vascular accidents. After decades of warfarin as the sole oral anticoagulant available in the United States, pharmacists are now being sought out for recommendations of appropriate use and reversal of these new agents in patients with multiple co-morbidities. This population is more often encountered in practice, but there is a paucity of data for their use supported by clinical trials. This module will analyze the available literature describing the use of DOACs in patients with renal and hepatic deficiency as well as those who are elderly and at the extremes of body weight. Off label use and evidence based recommendations for the reversal of these agents will be discussed. Patient cases will be utilized to facilitate learning and allow participants practice using this information to make evidence supported recommendations for their patients.

At the completion of this activity, the participant should be able to:

-Interpret literature supporting the use of direct acting oral anticoagulants (DOACs) in patients with comorbidities.
-Differentiate among the medications in the Factor Xa inhibitor class by indication, dosing recommendations and warnings.
-Choose the best DOAC for a patient with renal disease, hepatic insufficiency, old age and/or obesity when given a patient case.
-Compare approved and off-label DOAC reversal agents and strategies which are currently available.

This activity is designed to meet the educational needs of pharmacists practicing in a variety of settings.

MCPHS University is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education.


Mar 06, 2019


Pharmacy CPE





Credits / Hours

1 contact hour (.1 CEUs)



Presenters / Authors / Faculty

Amanda Morrill, PharmD, RPh, BCPS | Assistant Professor
MCPHS University

Keywords / Search Terms

MCPHS University, pharmacy, anticoagulants

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