Bloody Minded Episode 76 - On the Wards: A Practical Guide to Anticoagulants | Part 2 (Oral Anticoagulants)
Jan 27, 2026
A focused walkthrough of oral anticoagulants, covering warfarin history, mechanism and practical dosing tips. Clear guidance on monitoring, reversal strategies and tricky interactions. Deep dive into DOACs: dabigatran, rivaroxaban and apixaban dosing, monitoring limits and reversal options. Special circumstances like renal failure, pregnancy, obesity and perioperative management are highlighted.
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Warfarin And Pregnancy/Breastfeeding
- Do not use warfarin in pregnancy due to teratogenicity; switch to enoxaparin for pregnant patients.
- Warfarin is acceptable in breastfeeding because it does not enter breast milk.
DOAC Classes And Key Pharmacology
- DOACs include dabigatran (thrombin inhibitor) and rivaroxaban/apixaban (factor Xa inhibitors).
- Dabigatran requires renal dosing consideration because ~80% is renally cleared.
Managing Dabigatran Bleeding
- For dabigatran bleeding or urgent surgery, check thrombin time or dilute thrombin time and use idarucizumab for rapid reversal.
- Idarucizumab gives near-immediate reversal (two 2.5 g doses) but recheck coagulation and consider repeat dosing if renal failure delays dabigatran clearance.