Table 1.

The “Pros” and “Cons” of DOAC use for oral anticoagulation for AF. [DOAC, direct oral anticoagulant; VKA—vitamin K antagonist; ICH, intracerebral hemorrhage].

Advantage	Disadvantage
Predictable pharmacodynamics and pharmacokinetics.	Standardized tests for monitoring of DOAC activity are not easily available, when it is necessary in liver and kidney injury.
Low drug-drug and food interactions.	Currently lack a universal antidote
No dietary restriction.	High cost (in some countries)
Rapid onset and offset, short half life.	Experience limited to a decade
No need of regular laboratory monitoring unlike VKA	Needed dose modification in renal dysfunction
Wide therapeutic window.	Superiority against VKA for efficacy is yet to be achieved
DOACs can be started without LMWH due to their rapid onset.	Not indicated in pregnancy
Low rates of ICH (50% reduction)