What is the primary reason for avoiding extended DOAC therapy in patients with a history of bleeding?

The primary reason for avoiding extended direct oral anticoagulant (DOAC) therapy in patients with a history of bleeding is the risk of major bleeding. Patients with a known history of bleeding events are inherently at a higher risk for future bleeding complications when anticoagulation therapy is continued or extended.

DOACs, while effective for stroke prevention in conditions such as atrial fibrillation and for the treatment of venous thromboembolism, carry a risk of bleeding side effects, which can range from minor to life-threatening. The decision to extend DOAC therapy must always weigh the benefits of preventing thromboembolism against the potential for serious bleeding incidents. In patients with a prior history of bleeding, the likelihood of recurrence is significant enough to prompt caution and reconsideration of ongoing therapy, prioritizing patient safety to prevent adverse outcomes.

Other factors such as cost, noncompliance, and drug interactions can certainly influence treatment decisions, but they do not pose as direct a risk to patient safety in the same manner as the potential for major bleeding does in this context.