MDCalc

Direct-Acting Oral Anticoagulants (DOAC) Score

Predicts bleeding risk in patients with atrial fibrillation on DOAC.

Age, years

Creatinine clearance/estimated glomerular filtration rate (mL/min)

Underweight (body mass index <18.5 kg/m2)

Stroke/transient ischemic attack/embolism history

Diabetes

Hypertension

Antiplatelet use

Nonsteroidal anti-inflammatory (NSAID) use

Bleeding history

Liver disease

AST or ALT ≥3X upper limit of normal, ALP ≥2X upper limit of normal, or cirrhosis

Result:

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Advice
  • The decision to use anticoagulation therapy with a DOAC should consider multiple factors. This tool should not be the sole determinant of treatment planning, but should guide shared decision-making between the patient and clinician.
  • A high score is not necessarily a contraindication to DOAC therapy; clinical context is key.
  • Where possible, efforts should be made to address modifiable risk factors for bleeding.
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