Background: Direct acting oral anticoagulants (DOACs) have been approved for conditions such as non-valvular atrial fibrillation and venous thromboembolism. High quality randomized controlled trials have demonstrated the safety and efficacy of DOACs as compared to warfarin with exceptions in specific patient populations (such as those with mechanical heart valves). DOACs are more convenient and generally [...]

Case Presentation: A sixty-six-year-old male with a history of Monoclonal Gammopathy of Undetermined Significance (MGUS), Atrial Fibrillation, and Rheumatic Heart Disease requiring aortic and mitral valvuloplasty, was on warfarin with an INR goal of 3.5-4 due to multiple hypercoagulable factors and recurrent Transient Ischemic Attacks (TIAs) at INR 2.5-3.5. Post prostate cancer radiation, he developed [...]