What should be considered when deciding which direct-acting oral anticoagulant to use?
When deciding which direct-acting oral anticoagulant to use, factors such as renal impairment, swallowing difficulties, dosing frequency, and the person's clinical needs and preferences should be taken into account. Healthcare professionals should refer to the BNF for advice on contraindications and cautions, and discuss the risks and benefits of the different anticoagulants with the person as part of informed shared decision making. If direct-acting oral anticoagulants are not suitable, a vitamin K antagonist should be offered, and the benefits of changing from a vitamin K antagonist to a direct-acting anticoagulant should be discussed at the next routine appointment. The existing thresholds for the CHA2DS2-VASc score threshold for anticoagulation are in line with current practice.