Atrial fibrillation and venous thromboembolism are highly prevalent conditions posing a significant healthcare burden and representing the main indications for anticoagulation.

Compared to vitamin K antagonists, direct oral anticoagulants (DOACs) have a similar or better efficacy/safety profile, with significantly reduced of risk of intracerebral hemorrhage, while the risk of major bleeding and gastrointestinal bleeding may vary considering DOAC type and special populations.

Supportive measures can be used in most patients, while anticoagulant reversal agents are indicated for life-threatening bleeding complications. In most cases, resuming anticoagulation after a bleeding event will provide a net clinical benefit.

Careful assessment of patient characteristics and bleeding risk is key to choosing the most appropriate DOAC to try to minimize the risk of bleeding complications.

Apixaban, followed by edoxaban, shows the best efficacy/safety profile in the majority of patients.