DOAK

DOAK is an acronym sometimes used to refer to direct oral anticoagulants, a class of medicines that prevent blood clots. The more common abbreviation is DOAC (direct oral anticoagulant). DOAKs are taken by mouth and are used in many settings as alternatives to warfarin.

DOAKs work by directly inhibiting components of the coagulation cascade. They fall into two main groups: direct factor Xa inhibitors (such as apixaban, rivaroxaban, edoxaban, and betrixaban) and a direct thrombin inhibitor (dabigatran). By blocking these target proteins, DOAKs reduce thrombin generation and clot formation.

Indications for DOAKs include reducing stroke risk in nonvalvular atrial fibrillation, treatment and prevention of venous thromboembolism (including deep vein thrombosis and pulmonary embolism), and prophylaxis after hip or knee replacement in selected patients. They are used in various other clinical scenarios as determined by guidelines and patient factors.

Advantages of DOAKs include predictable pharmacokinetics, fixed dosing, and the lack of routine laboratory monitoring required with some older anticoagulants. Limitations include a need to monitor kidney function and potential drug interactions. Bleeding remains a significant risk, and DOAKs are not suitable for all patients—for example, they are generally avoided in many patients with certain mechanical heart valves or severe kidney disease.

Reversal and monitoring considerations vary by agent. Routine coagulation tests do not reliably reflect DOAK activity. Specific reversal agents exist for some DOAKs (andexanet alfa for factor Xa inhibitors; idarucizumab for dabigatran). In certain cases, non-specific reversal methods or supportive measures may be used if reversal agents are unavailable.