Direct oral anticoagulants are convenient after arthroplasty, but they are not right for everyone. Before prescribing, check kidney function, because these drugs are cleared partly by the kidney and doses or choice change with reduced clearance. Review the medication list for interacting drugs, especially strong enzyme inhibitors or inducers and other antithrombotics. And confirm the patient has no condition where a DOAC is unsuitable, such as a mechanical heart valve.
- Check creatinine clearance before prescribing.
- Review for interacting drugs and other antiplatelets or anticoagulants.
- Exclude mechanical heart valves and other contraindications.
- Give clear written instructions on duration and when to stop.
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