, Volume 79, Issue 15, pp 1625–1634 | Cite as

Clinical Management of Pharmacokinetic Drug Interactions with Direct Oral Anticoagulants (DOACs)

  • Megan C. HerinkEmail author
  • Yan F. Zhuo
  • Craig D. Williams
  • Thomas G. DeLoughery
Review Article


Compared with warfarin, the direct-acting oral anticoagulants (DOAC) have fewer pharmacokinetic drug interactions. However, significant drug interactions do exist with documented changes in DOAC concentrations, which can exceed 100%. Unlike warfarin, DOACs have no validated surrogate test to monitor the intensity of anticoagulation. However, several analyses of major outcomes trials with DOACs have demonstrated that serum concentrations do affect both the thrombotic benefits and the hemorrhagic risks of these agents. This paper reviews the known significant pharmacokinetic interactions with DOACs and includes considerations for their use in the presence of interacting medications.


Compliance with Ethical Standards


No sources of funding were used to conduct this study or prepare this manuscript.

Conflict of interest

MH, YZ, CW and TD have no potential conflicts of interest that might be relevant to the contents of this manuscript.


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© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of Pharmacy PracticeOSU/OHSU College of PharmacyPortlandUSA
  2. 2.Department of HematologyOHSU School of MedicinePortlandUSA

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