With their ease of use the Direct oral anticoagulants (DOACs) are increasingly replacing vitamin k antagonists (VKAs) as the oral anticoagulant of choice in the management of atrial fibrillation and venous thromboembolism. Although the DOACs were demonstrated to be efficacious and safe compared to VKAs in the large phase 3 trials, the studies had limited representation of the elderly and those of extremes of weight. This limited representation has led to theoretical concerns regarding the use of DOACs with their fixed dosing and lack of routine monitoring in these demographics, including concerns of increased bleeding risk in frail elderly patients, and either under or over-anticoagulation in those of extremes of weight. This presentation will review these concerns and the evidence surrounding the use of DOACs in the elderly and those of extremes of weight. This presentation from the Thrombosis Canada Virtual Conference 2020 is by Dr Jameel Abdulrehman, UHN
