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Although the risk of major bleeding, in particular intracranial haemorrhage (ICH), is decreased with DOACs, gastrointestinal bleeding is increased with some DOACs, and the case fatality rate of bleeding remains high. Therefore, it is important to (i) prescribe DOACs appropriately, (ii) have strategies to manage major bleeding including the use of specific reversal agents and (iii) interrupt and resume DOACs for procedures. The main recommendations are as follows: (i) Select the appropriate dose of DOAC according to indications and consider patient factors to minimise bleeding risks; (ii) DOACs do not require routine laboratory testing; (iii) for life\u2010threatening uncontrollable bleeding, specific agents can be used to reverse the anticoagulant effects of DOACs; and (iv) DOACs can be interrupted for planned procedures without the need for \u2018bridging\u2019 with low\u2010molecular\u2010weight heparin (LMWH). The anticoagulant effects of DOACs can be reversed with specific agents, such as andexanet for apixaban and rivaroxaban and idarucizumab for dabigatran. If not available, pro\u2010haemostatic agents such as prothrombin complex concentrates or activated prothrombin complex concentrates can be considered. DOACs can be interrupted and resumed for procedures without the need for \u2018bridging\u2019 with LMWH.<\/jats:p>","DOI":"10.1111\/imj.70103","type":"journal-article","created":{"date-parts":[[2025,5,31]],"date-time":"2025-05-31T13:24:47Z","timestamp":1748697887000},"page":"1174-1183","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":32,"title":["2025 Guidelines for direct oral anticoagulants: a practical guidance on the prescription, laboratory testing, peri\u2010operative and bleeding management"],"prefix":"10.1111","volume":"55","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1989-959X","authenticated-orcid":false,"given":"Huyen A.","family":"Tran","sequence":"first","affiliation":[{"name":"Haemostasis Thrombosis Unit The Alfred Hospital  Melbourne Victoria Australia"},{"name":"Australian Centre for Blood Diseases Monash University  Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2234-4982","authenticated-orcid":false,"given":"Eileen","family":"Merriman","sequence":"additional","affiliation":[{"name":"Haematology Department Royal North Shore Hospital  Auckland New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ross","family":"Baker","sequence":"additional","affiliation":[{"name":"Haematology Department Perth Blood Institute  Perth Western Australia Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer","family":"Curnow","sequence":"additional","affiliation":[{"name":"Haematology Department Westmead Hospital  Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Young","sequence":"additional","affiliation":[{"name":"Haematology Department Auckland City Hospital  Auckland New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chee Wee","family":"Tan","sequence":"additional","affiliation":[{"name":"Haematology Department Royal Adelaide Hospital  Adelaide South Australia Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simon","family":"McRae","sequence":"additional","affiliation":[{"name":"Department of Haematology Launceston General Hospital  Launceston Tasmania Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sanjeev D.","family":"Chunilal","sequence":"additional","affiliation":[{"name":"Haematology Department Monash Medical Centre  Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,5,31]]},"reference":[{"key":"e_1_2_5_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtha.2023.02.008"},{"key":"e_1_2_5_3_1","doi-asserted-by":"publisher","DOI":"10.2147\/PPA.S131157"},{"key":"e_1_2_5_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(13)62343-0"},{"key":"e_1_2_5_5_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1709118"},{"key":"e_1_2_5_6_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2014-04-571232"},{"key":"e_1_2_5_7_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0905561"},{"key":"e_1_2_5_8_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1207541"},{"key":"e_1_2_5_9_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1700518"},{"key":"e_1_2_5_10_1","unstructured":"Australian Medicines Handbook.Drug interactions search. 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