The Curbsiders Internal Medicine Podcast #499 Inpatient DOAC Dilemmas with Dr. Jori May
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Sep 22, 2025 Dr. Jori May, an expert in thrombosis and coagulation at the University of Alabama-Birmingham, dives into the complexities of DOAC treatment in hospitalized patients. He discusses what constitutes anticoagulation failure and the key factors to consider, such as missed doses and patient adherence. Insights on when to switch to warfarin, the implications of D-dimer levels, and the evaluation of anatomical causes of thrombosis are highlighted. Dr. May emphasizes the importance of thorough assessment before changing anticoagulation therapies, ensuring effective patient care.
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Prove Anticoagulation Before Labeling Failure
- Verify anticoagulation adherence and dosing before declaring treatment failure.
- Call the pharmacy for fill history and confirm dose timing and formulation details.
Check How Patients Take DOACs
- Ask if the patient actually takes the DOAC twice daily or with food as required.
- Confirm the prescribed dose matches the indication (eg VTE vs AFib dose).
Look Beyond The Drug For Failure Causes
- Malignancy, antiphospholipid syndrome, and anatomical stasis often drive apparent DOAC failure.
- Anticoagulation has limits; look for hypercoagulability, endothelial injury, or stasis.