DIRECT ORAL ANTICOAGULANTS IN PRIMARY AND SECONDARY PREVENTION OF THROMBOTIC EVENTS: 2026 ACC SCIENTIFIC STATEMENT

American College of Cardiology

Direct oral anticoagulants (DOACs) have transformed the prevention and treatment of thromboembolic disease, offering predictable pharmacokinetics, fewer interactions, and improved safety compared with vitamin K antagonists. Over the past decade, DOACs have become the preferred oral anticoagulants for most patients with atrial fibrillation and venous thromboembolism. However, important gaps remain in their optimal implementation across diverse clinical scenarios, particularly among patients at elevated thrombotic risk and in populations historically underrepresented in randomized trials. This scientific statement addresses these issues and provides guidance on the use of DOACs.