Support change but why did you remove the part that explains what drugs are under the broad term “DOAC”
“DOACs = Direct oral anticoagulants, which include direct factor Xa inhibitors (e.g., rivaroxaban, apixaban, or edoxaban) or direct thrombin inhibitors (e.g., dabigatran)”
I think its worth adding DOAC includes the direct thrombin inhibitors and not just the -xaban drugs
How do you initiate anticoagulation in stable DVT patients?
First-line: {{c1::use DOAC}}
Second-line: {{c1::use heparin bridge (LMWH or UFH) to warfarin}}
- Direct oral anticoagulants are preferred because no heparin bridging required; DOACs include direct factor Xa inhibitors (e.g., rivaroxaban, apixaban) AND direct thrombin inhibitors (e.g., dabigatran)
didn’t want to make edits to change your suggest, but something like this is what I was thinking? It shortens the actual cloze statements and doesn’t remove the added explanation from extra.
I’m actually fine with any wording changes here as long as they address my main point (that we don’t always start with heparin and then switch to a DOAC in acute DVT)
The wording itself isn’t a big concern for me. My issue in fully supporting your suggestion is that not all DOACs can be given immediately (some like thrombin inhibitors require a heparin bridge)
As for the extra note I removed, it was for the same reason, I didn’t want to imply that the statement applies in all cases. I also felt that explaining the need for a heparin bridge in some DOACs might be too complicated
I was under the impression only warfarin requires a heparin bridge due to the initial hypercoagulable state if you start warfarin suddenly without heparin. Amboss only mentions it is required for vitamin K antagonist
Bridging anticoagulation with a parenteral agent is not required for DOACs. [2][9]
https://next.amboss.com/us/article/2r0Tgh?q=heparin%20bridge#I51Ylh0
Based on the DVT article in AMBOSS, we use heparin for about a week before switching to a direct thrombin inhibitor. This is not exactly bridge therapy, as I initially phrased it. Amboss refers to it as lead-in therapy, as there is no overlap between heparin and DTIs
Agree with @IantheBFG - support minor changes to text, don’t think we need to overhaul the extra