Short, practical rules for the decisions that come up on every ward round.
Choosing an agent
For most patients with non-valvular atrial fibrillation, a direct oral anticoagulant is the default. Mechanical valves and antiphospholipid syndrome remain warfarin territory.
Around procedures
Hold times depend on renal function and bleeding risk, not on habit. Write the restart date in the plan — missed restarts cause more harm than the hold itself.
When bleeding happens
Know where your reversal agents are kept before you need them at three in the morning.
