When should I consider switching a patient from Warfarin to a DOAC, and what factors should influence this decision?

Consider switching a patient from warfarin to a direct oral anticoagulant (DOAC) if the patient has atrial fibrillation and a CHA2DS2-VASc score of 2 or above, or a score of 1 in men, taking into account bleeding risk and patient preferences. DOACs such as apixaban, dabigatran, edoxaban, and rivaroxaban are recommended options when used according to NICE technology appraisal guidance. For patients already stable on warfarin, continue current treatment but discuss the option of switching at their next routine appointment, considering their time in therapeutic range and INR control quality. Factors influencing the decision include contraindications, tolerability, renal function, bleeding risk, patient preference, and drug interactions. DOACs are generally preferred unless contraindicated or unsuitable, in which case vitamin K antagonists like warfarin remain appropriate. Age or risk of falls alone should not preclude anticoagulation or switching to DOACs. An informed discussion about risks and benefits of each anticoagulant option is essential to shared decision making.