Table 20.

Drug-specific educational points for DOACs and VTE treatment [11, 12, 15, 16]

Patient and family educational needs
Warfarin	Dabigatran	Rivaroxaban	Apixaban	Edoxaban
Daily, dose-adjusted	Twice daily	Daily (initially twice daily)	Twice daily	Daily
	Various dose adjustments recommended based on indications, kidney or liver function, and/or concomitant drugs
Missed dose	Missed dose: take as soon as possible on the same day but 6 h before next scheduled dose	If missed a 15 mg dose, can take 30 mg one time to make up	Take as soon as possible same day	Take as soon as possible on the same day
Take if before midnight on same day
Call warfarin manager
Do not double up to make up for missed dose
+/− food	Take with full glass of water, +/− food	Take with food	+/− food	+/− food
Weekly pill planner can aid compliance	MUST store in original container, keep sealed, use capsules in 120 days	Weekly pill planner can aid compliance
Can crush, mix with food	Swallow whole, do NOT cut, open, or crush	Can crush and give via NG or gastric tube or mix with food	Can crush, suspend in D5 W and give via NG tube	No data regarding crushing, so crushing not recommended
Numerous drug:drug interactions, report all to warfarin manager	Important drug:drug interactions: P-gp inducers and inhibitors (especially if renal function compromised)	Avoid dual P-gp and strong CYP 3A4 inducers or inhibitors	Avoid dual P-gp and strong CYP 3A4 inducers or inhibitors	Important drug:drug interactions: P-gp inducers and inhibitors
Inform provider of all medication changes, including over-the-counter and herbals
Carry “anticoagulant ID wallet card” to alert emergency medical responders
DO NOT stop taking without a physician order (get prescriptions refilled on time)
Report signs and symptoms of bleeding and/or potential clotting
Inform all health care providers before invasive procedures or surgery, including dental
Inform health care provider if pregnant or plan to become pregnant
Inform health care provider if breastfeeding
Careful planning and communication around transition of care episodes

DOAC direct oral anticoagulant, VTE venous thromboembolism, NG nasogastric