Journal of Thrombosis and Thrombolysis

, Volume 47, Issue 1, pp 146–154 | Cite as

Direct oral anticoagulants: a review of common medication errors

  • Drakeria BarrEmail author
  • Quovadis J. Epps


Stroke and venous thromboembolism continues to be a major cause of morbidity and mortality worldwide. The use of anticoagulation therapy has proven effective in the prevention of stroke and management of thromboembolism; however, initiating treatment may bear clinical burden given the capacity of these agents to cause bleeding. Originally, warfarin has been primarily used, but with the approval of direct oral anticoagulants, therapeutic recommendations have shifted to direct oral anticoagulants for first line therapy for venous thromboembolism for patients without cancer. As compared to warfarin, direct oral anticoagulants are associated with predictable pharmacokinetic profiles, lower bleeding risks, and minimal drug interactions. Complexities in the medication use process can however heighten the risks of causing adverse events. The purpose of this article is to describe common medication errors associated with direct oral anticoagulants, provide practical guidance on the management of direct oral anticoagulants, and suggest strategies to reduce errors. Efforts to minimize medication errors involve the participation of an interdisciplinary team that has standardized policies, risk reduction strategies, and guiding principles to achieve optimal therapeutic outcomes. Current primary literature is not robust in assessment of clinical impact of medication errors associated with DOACs but reports of adverse drug events have been noted. Future studies should be guided to assess clinical outcomes associated with medication errors and identify potential clinical interventions to optimize therapy.


Anticoagulation DOAC Medication error Risk reduction 



This study was performed without financial support.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Research involving human participants

This article does not contain any studies with human participants performed by any of the authors.


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© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.College of PharmacyFlorida Agricultural & Mechanical UniversityJacksonvilleUSA

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