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DOACs are FDA approved for the following conditions 359 : Stroke prevention in non-valvular atrial fibrillation (NVAF) Prevention of thromboembolism after total hip and knee replacement Treatment of DVT and pulmonary embolism Prevention of recurrent DVT and pulmonary embolism Prevention of thromboembolisms in hospitalized, acutely ill patients Prevention of major cardiovascular events in patients with chronic coronary artery disease and peripheral artery disease Despite their many advantages over warfarin, there are contraindications for the use of DOACs, including the following: Having a mechanical (versus a bioprosthetic) heart valve Moderate-to-severe mitral stenosis Severe kidney and liver disease Gastrointestinal absorption issues from either disease states or bariatric surgery In these instances, if anticoagulation is needed, warfarin or heparin may be recommended as a first-line anticoagulation agent