Assessment of Population-Based Approach to Direct Oral Anticoagulant Management.

Background: As preferences for oral anticoagulation shift from warfarin to direct oral anticoagulants (DOACs), a new care management model is needed. A population approach leveraging a DOAC Dashboard was implemented to track all patients on a DOAC followed by a physician at an academic medical center. The DOAC Dashboard is a real-time report within the electronic health record (EHR) that identifies patients who require evaluation for DOAC dose/therapy adjustment due to changing renal function, age, weight, indication, and/or significant drug-drug interaction (DDI). Objective: This study aims to describe the initial phase of DOAC Dashboard implementation, to evaluate the effectiveness of interventions, and to assess a multidisciplinary approach to management. Method: Retrospective descriptive study of the DOAC Dashboard from August 22, 2019, to January 20, 2022. Primary outcomes include total number of alerts addressed and interventions needed. Secondary outcome is the proportion of interventions implemented by the prescribing clinician. Result: A total of 10 912 patients were identified by the DOAC Dashboard at baseline. A total of 5038 alerts were identified, with 668 critical alerts, 3337 possible critical alerts, and 1033 other alerts. Pharmacists addressed 1796 alerts during the study period (762 critical alerts and 1034 possible critical). Critical alerts included 62 significant DDI, 379 inappropriate dosing, and 321 others. Of the critical alerts, intervention was needed in 291 cases (38%), with 255 (88%) of proposed interventions implemented. Critical alerts and possible critical alerts not requiring intervention were resolved by data entry. Conclusion: The DOAC Dashboard provides an efficient method of identifying patients on DOACs that require dose adjustments or therapeutic modifications.

Capuchin monkeys learn to use information equally well from individual exploration and social demonstration.

The limited evidence of complex culture in non-human primates contrasts strikingly with human behaviour. This may be because non-human primates fail to use information acquired socially as effectively as they use information acquired individually. Here, monkeys were trained on a stimulus discrimination task with a win-stay, lose-shift (WSLS) reward structure. In a social learning condition, the experimenter performed an information trial by choosing between the available stimuli; in an individual condition, monkeys made this choice themselves. The monkeys' subsequent test trials displayed the same stimulus array. They were rewarded for repetition of rewarded ('win-stay') and avoidance of unrewarded ('lose-shift') information trial selections. Nine monkeys reached our pre-determined performance criterion on the initial two-stimulus stage. Their ability to generalise the WSLS strategy was then evaluated by transfer to a three-stimulus stage. Minimal differences were found in information use between the social and individual conditions on two-stimuli. However, a bias was found towards repetition of the information trial, regardless of information source condition or whether the information trial selection was rewarded. Proficient subjects were found to generalise the strategy to three-stimuli following rewarded information trials, but performed at chance on unrewarded. Again, this was not found to vary by source condition. Overall, results suggest no fundamental barrier to non-human primates' use of information from a social source. However, the apparent struggle to learn from the absence of rewards hints at a difficulty with using information acquired from unsuccessful attempts; this could be linked to the limited evidence for cumulative culture in non-human primates.

Proportion of Patients on Warfarin Therapy Who Are Eligible for Conversion to a Direct Oral Anticoagulant in the Setting of COVID-19.

BACKGROUND: Warfarin, a commonly prescribed anticoagulant, requires frequent lab monitoring. Lab monitoring puts patients at risk of COVID-19 exposure and diverts medical resources away from health care systems. Direct oral anticoagulants (DOACs) do not require routine therapeutic monitoring and are indicated first line for nonvalvular atrial fibrillation (NVAF) stroke prevention and venous thromboembolism (VTE) prevention/treatment. OBJECTIVE: The purpose of the study was to determine the proportion of patients who qualify for DOACs and assess for predictors of qualification. METHODS: This cross-sectional study investigated patients on warfarin managed by Michigan Medicine Anticoagulation Service. Direct oral anticoagulant eligibility criteria were established using apixaban, dabigatran, and rivaroxaban package inserts. Patient eligibility was determined through chart review. The primary outcome was the proportion of patients who qualify for DOACs based on clinical factors. Predictors of DOAC qualification were assessed. RESULTS: This study included 3205 patients and found 51.8% (n = 1661) of patients qualified for DOACs. Qualifying patients were older (71.9 vs 59.4 years, P < 0.0001) with a higher CHA2DS2 VASc (3.7 vs 3.4, P < 0.0007). The primary disqualifying factor was extreme weight, high and low. Accounting for a patient's sex and referral source, age > 65 (odds ratio [OR] = 1.9, P < 0.0001) and NVAF indication (OR = 5.6, P < 0.0001) were significant predictors for DOAC qualification. CONCLUSION AND RELEVANCE: Approximately 52% of patients on warfarin were eligible for DOACs. This presents an opportunity to reduce patient exposure to health care settings and health care utilization in the setting of COVID-19. Increased costs of DOACs need to be assessed.

Taking account of others' goals in social information use: Developmental changes in 3- to 7-year-old children.

The ability to take mental states such as goals into account when interpreting others' behavior has been proposed to be what sets human use of social information apart from that of other animals. If so, children's social information use would be expected to change as their understanding of others' mental states develops. We explored age-related changes in 3- to 7-year-old children's ability to strategically use social information by taking into account another's goal when it was, or was not, aligned with their own. Children observed as a puppet demonstrator selected a capsule, peeked inside, and chose to accept or reject it, following which children made their own selection. Children were able to account for others' conflicting motivations from around 4 years of age and reliably inferred the outcome of others' behavior from 6 years. However, using social information based on such inferences appeared to be challenging regardless of whether the demonstrator's goal was, or was not. aligned to that of the participant. We found that social information use improved with age; however, this improvement was restricted to cases in which the appropriate response was to avoid copying the demonstrator's selection. In contrast to previous research, appropriate copying responses remained at chance. Possible explanations for this unexpected pattern of results are discussed. The cognitive challenge associated with the ability to account for others' goals could offer humans a significant advantage over that of other animals in their ability to use social information.

Restricted Access to Working Memory Does Not Prevent Cumulative Score Improvement in a Cultural Evolution Task.

Some theories propose that human cumulative culture is dependent on explicit, system-2, metacognitive processes. To test this, we investigated whether access to working memory is required for cumulative cultural evolution. We restricted access to adults' working-memory (WM) via a dual-task paradigm, to assess whether this reduced performance in a cultural evolution task, and a metacognitive monitoring task. In total, 247 participants completed either a grid search task or a metacognitive monitoring task in conjunction with a WM task and a matched control. Participants' behaviour in the grid search task was then used to simulate the outcome of iterating the task over multiple generations. Participants in the grid search task scored higher after observing higher-scoring examples, but could only beat the scores of low-scoring example trials. Scores did not differ significantly between the control and WM distractor blocks, although more errors were made when under WM load. The simulation showed similar levels of cumulative score improvement across conditions. However, scores plateaued without reaching the maximum. Metacognitive efficiency was low in both blocks, with no indication of dual-task interference. Overall, we found that taxing working-memory resources did not prevent cumulative score improvement on this task, but impeded it slightly relative to a control distractor task. However, we found no evidence that the dual-task manipulation impacted participants' ability to use explicit metacognition. Although we found minimal evidence in support of the explicit metacognition theory of cumulative culture, our results provide valuable insights into empirical approaches that could be used to further test predictions arising from this account.

Cognitive prerequisites for cumulative culture are context-dependent: Children's potential for ratcheting depends on cue longevity.

Human cumulative culture has been suggested to depend on human-unique cognitive mechanisms, explaining its apparent absence in other species. We show that the potential for exhibiting cumulative culture depends on the cognitive abilities of the agents and the demands associated with using information generated by others' activity. 154 children aged 3-6 years played a searching game ("Find the Treasure"), taking their turn after a puppet demonstrator. The puppet's attempt revealed information about the contents of the locations searched, which could be exploited to target rewarded locations, and avoid unrewarded ones. Two conditions were presented, intended to capture realistic variation in the transience of the cues generated by another individual's activity. In one condition, the puppet's demonstration provided transient information - boxes were opened, seen to be rewarded or not, and then closed. In the other condition the puppet's chosen boxes remained partially open, providing an enduring visible cue as to whether that location was rewarded. Children undertook three trials of varying demonstration success, and we used patterns of performance to infer the potential for improvement over multiple generations of transmission. In the Enduring Cues condition, children's performance demonstrated the potential for cumulative culture. In contrast, in the Transient Information condition, only older children showed improved performances following higher success demonstrations and overall performance was not compatible with the possibility of improvements over generations of social transmission. We conclude that under certain conditions cumulative culture could occur in many species, but in a broader range of contexts in humans.

Clinical Safety Outcomes in Patients With Nonvalvular Atrial Fibrillation on Rivaroxaban and Diltiazem.

BACKGROUND: It is unknown whether diltiazem, a moderate cytochrome P450 enzyme (CYP3A4) and P-glycoprotein (P-gp) inhibitor, increases the incidence of bleeding events in combination with rivaroxaban, a CYP3A4 and P-gp substrate. OBJECTIVE: To assess major and clinically relevant nonmajor (CRNM) bleeding outcomes in patients with nonvalvular atrial fibrillation (NVAF) on rivaroxaban with concomitant diltiazem in a real-world setting. METHODS: This retrospective case-cohort study included adult patients with NVAF prescribed both rivaroxaban and diltiazem for at least 30 days. Patients were matched 1:1 by age and baseline creatinine clearance (CrCl) to control patients taking rivaroxaban alone. The primary outcome was the composite of major and CRNM bleeding. Additional outcomes included bleeding events resulting in discontinuation of rivaroxaban, time to first bleeding event, and type of first bleed. RESULTS: A total of 143 cases and 143 controls were included. The mean age was 69 years and median baseline CrCl was 87 mL/min. Median follow-up time was 12.4 months for cases and 16.5 months for controls. There was no significant difference in proportion of patients experiencing a major and/or CRNM bleeding event between cases and controls: 23.1% versus 28.0%, respectively; 9 cases and 8 controls permanently discontinued rivaroxaban because of bleeding. Gastrointestinal/rectal bleeding and hematuria were the most frequently reported bleeding events in both groups. Conclusion and Relevance: This is the first study to assess major and CRNM bleeding outcomes in patients with NVAF on rivaroxaban and diltiazem. Diltiazem use was not associated with an increased rate of bleeding events.

Pattern and process in hominin brain size evolution are scale-dependent.

A large brain is a defining feature of modern humans, yet there is no consensus regarding the patterns, rates and processes involved in hominin brain size evolution. We use a reliable proxy for brain size in fossils, endocranial volume (ECV), to better understand how brain size evolved at both clade- and lineage-level scales. For the hominin clade overall, the dominant signal is consistent with a gradual increase in brain size. This gradual trend appears to have been generated primarily by processes operating within hypothesized lineages-64% or 88% depending on whether one uses a more or less speciose taxonomy, respectively. These processes were supplemented by the appearance in the fossil record of larger-brained Homo species and the subsequent disappearance of smaller-brained Australopithecus and Paranthropus taxa. When the estimated rate of within-lineage ECV increase is compared to an exponential model that operationalizes generation-scale evolutionary processes, it suggests that the observed data were the result of episodes of directional selection interspersed with periods of stasis and/or drift; all of this occurs on too fine a timescale to be resolved by the current human fossil record, thus producing apparent gradual trends within lineages. Our findings provide a quantitative basis for developing and testing scale-explicit hypotheses about the factors that led brain size to increase during hominin evolution.

Insightful problem solving and emulation in brown capuchin monkeys.

We investigated problem solving abilities of capuchin monkeys via the "floating object problem," a task in which the subject must use creative problem solving to retrieve a favored food item from the bottom of a clear tube. Some great apes have solved this problem by adding water to raise the object to a level at which it can be easily grabbed. We presented seven capuchins with the task over eight trials (four "dry" and four "wet"). None of the subjects solved the task, indicating that no capuchin demonstrated insightful problem solving under these experimental conditions. We then investigated whether capuchins would emulate a solution to the task. Seven subjects observed a human model solve the problem by pouring water from a cup into the tube, which brought the object to the top of the tube, allowing the subject to retrieve it. Subjects were then allowed to interact freely with an unfilled tube containing the object in the presence of water and objects that could be used to solve the task. While most subjects were unable to solve the task after viewing a demonstrator solve it, one subject did so, but in a unique way. Our results are consistent with some previous results in great ape species and indicate that capuchins do not spontaneously solve the floating object problem via insight.

Sequential recall of meaningful and arbitrary sequences by orangutans and human children: Does content matter?

Do visual cues such as size, color, and number facilitate sequential recall in orangutans and human children? In Experiment 1, children and adult orangutans solved two types of sequences, arbitrary (unrelated pictures) and meaningful (pictures varied along a spectrum according to the size, color, or number of items shown), in a touchscreen paradigm. It was found that visual cues did not increase the percentage of correct responses for either children or orangutans. In order to demonstrate that the failure to spontaneously seriate along these dimensions was not due to a general inability to perceive the dimensions nor to an inability to seriate items, in Experiment 2, orangutans were trained on one type of sequence and tested on novel sequences organized according to the same rule (i.e., pictures varied on the number spectrum only). The orangutans performed significantly better on novel meaningful sequences in this task than on novel arbitrary sequences. These results indicate that, while orangutans and human children share the ability to learn how to order items according to their size, color, or number, both orangutans and humans lack a cognitive propensity to spontaneously (i.e., without prior training or enculturation) order multiple items by size, color, or number.

Becoming a high-fidelity - super - imitator: what are the contributions of social and individual learning?

In contrast to other primates, human children's imitation performance goes from low to high fidelity soon after infancy. Are such changes associated with the development of other forms of learning? We addressed this question by testing 215 children (26-59 months) on two social conditions (imitation, emulation) - involving a demonstration - and two asocial conditions (trial-and-error, recall) - involving individual learning - using two touchscreen tasks. The tasks required responding to either three different pictures in a specific picture order (Cognitive: Airplane→Ball→Cow) or three identical pictures in a specific spatial order (Motor-Spatial: Up→Down→Right). There were age-related improvements across all conditions and imitation, emulation and recall performance were significantly better than trial-and-error learning. Generalized linear models demonstrated that motor-spatial imitation fidelity was associated with age and motor-spatial emulation performance, but cognitive imitation fidelity was only associated with age. While this study provides evidence for multiple imitation mechanisms, the development of one of those mechanisms - motor-spatial imitation - may be bootstrapped by the development of another social learning skill - motor-spatial emulation. Together, these findings provide important clues about the development of imitation, which is arguably a distinctive feature of the human species.

Fetching felines: a survey of cat owners on the diversity of cat (Felis catus) fetching behaviour.

Domesticated animals are famous for the ease with which they can accommodate to diverse human environments and roles, but less well-studied is the ease with which domestic animals can manipulate their human caregivers to their own ends. For example, domestic animals may start and end their play behaviour with humans at times of their choice. Here we present the results of a survey of 924 cat owners who report fetching behaviour in 1154 cats. The overwhelming majority (94.4%) of these owners report that fetching emerged in the absence of explicit training. Fetching was primarily first noticed when the cats were less than one year old (n = 701) or 1-7 years old (n = 415). Cats initiated and terminated fetching bouts more often than did their owners. Thus, cats who fetch demonstrate independent and co-ordinated agency in the onset and maintenance of fetching behaviour with their human partners. Additional findings highlight the diversity of objects fetched and the diversity in household demographics. Our thematic analysis reveals owners' perspectives on (a) the process of a fetching session, (b) the initial acquisition of fetching, and (c) the circumstantial factors that influence fetching patterns. In summary, cats who fetch largely determine when they engage in fetching sessions and actively influence the play behaviour of their owners.

Are there dedicated neural mechanisms for imitation? A study of grist and mills.

Are there brain regions that are specialized for the execution of imitative actions? We compared two hypotheses of imitation: the mirror neuron system (MNS) hypothesis predicts frontal and parietal engagement which is specific to imitation, while the Grist-Mills hypothesis predicts no difference in brain activation between imitative and matched non-imitative actions. Our delayed imitation fMRI paradigm included two tasks, one where correct performance was defined by a spatial rule and another where it was defined by an item-based rule. For each task, participants could learn a sequence from a video of a human hand performing the task, from a matched "Ghost" condition, or from text instructions. When participants executed actions after seeing the Hand demonstration (compared to Ghost and Text demonstrations), no activation differences occurred in frontal or parietal regions; rather, activation was localized primarily to occipital cortex. This adds to a growing body of evidence which indicates that imitation-specific responses during action execution do not occur in canonical mirror regions, contradicting the mirror neuron system hypothesis. However, activation differences did occur between action execution in the Hand and Ghost conditions outside MNS regions, which runs counter to the Grist-Mills hypothesis. We conclude that researchers should look beyond these hypotheses as well as classical MNS regions to describe the ways in which imitative actions are implemented by the brain.

Children transition from simple associations to explicitly reasoned social learning strategies between age four and eight.

To differentiate the use of simple associations from use of explicitly reasoned selective social learning, we can look for age-related changes in children's behaviour that might signify a switch from one social learning strategy to the other. We presented 4- to 8-year-old children visiting a zoo in Scotland (N = 109) with a task in which the perceptual access of two informants was determined by the differing opacity of two screens of similar visual appearance during a hiding event. Initially success could be achieved by forming an association or inferring a rule based on salient visual (but causally irrelevant) cues. However, following a switch in the scenario, success required explicit reasoning about informants' potential to provide valuable information based on their perceptual access. Following the switch, older children were more likely to select a knowledgeable informant. This suggests that some younger children who succeeded in the pre-switch trials had inferred rules or formed associations based on superficial, yet salient, visual cues, whereas older children made the link between perceptual access and the potential to inform. This late development and apparent cognitive challenge are consistent with proposals that such capacities are linked to the distinctiveness of human cumulative culture.

Limited evidence for executive function load impairing selective copying in a win-stay lose-shift task.

The use of 'explicitly metacognitive' learning strategies has been proposed as an explanation for uniquely human capacities for cumulative culture. Such strategies are proposed to rely on explicit, system-2 cognitive processes, to enable advantageous selective copying. To investigate the plausibility of this theory, we investigated participants' ability to make flexible learning decisions, and their metacognitive monitoring efficiency, under executive function (EF) load. Adult participants completed a simple win-stay lose-shift (WSLS) paradigm task, intended to model a situation where presented information can be used to inform response choice, by copying rewarded responses and avoiding those that are unrewarded. This was completed alongside a concurrent switching task. Participants were split into three conditions: those that needed to use a selective copying, WSLS strategy, those that should always copy observed information, and those that should always do the opposite (Expt 1). Participants also completed a metacognitive monitoring task alongside the concurrent switching task (Expt 2). Conditions demanding selective strategies were more challenging than those requiring the use of one rule consistently. In addition, consistently copying was less challenging than consistently avoiding observed stimuli. Differences between selectively copying and always copying were hypothesised to stem from working memory requirements rather than the concurrent EF load. No impact of EF load was found on participants' metacognitive monitoring ability. These results suggest that copying decisions are underpinned by the use of executive functions even at a very basic level, and that selective copying strategies are more challenging than a combination of their component parts. We found minimal evidence that selective copying strategies relied on executive functions any more than consistent copying or deviation. However, task experience effects suggested that ceiling effects could have been masking differences between conditions which might be apparent in other contexts, such as when observed information must be retained in memory.

The use of individual, social, and animated cue information by capuchin monkeys and children in a touchscreen task.

The distinctiveness of human cumulative culture raises the question of whether humans respond differently to information originating from social sources, compared with information from other sources. Further, does any such differential responding set humans apart from other species? We studied how capuchin monkeys and 2- to 5-year-old children used information originating from their own actions, those of a human demonstrator, or an animated cue. This information, presented via a touchscreen, always revealed in the first trial (T1) the reward value (rewarded or unrewarded) of one stimulus from a 2- or 3-item array, and could be used in a follow-up trial (T2) involving the same stimulus array. Two monkeys achieved a level of proficiency indicating their appreciation of the T1-T2 relationship, i.e., reliably repeating rewarded ("win") selections and actively avoiding repetition of unrewarded ("lose") selections well above chance levels. Neither the two task-proficient monkeys nor the children showed overall performance differences between the three source conditions. Non-task-proficient monkeys, by contrast, did show effects of source, performing best with individually-acquired information. The overall pattern of results hints at an alternative perspective on evidence typically interpreted as showing a human advantage for social information use.

Robust, source-independent biases in children's use of socially and individually acquired information.

Culture has an extraordinary influence on human behavior, unparalleled in other species. Some theories propose that humans possess learning mechanisms biologically selected specifically for social learning, which function to promote rapid enculturation. If true, it follows that information acquired via observation of another's activity might be responded to differently, compared with equivalent information acquired through one's own exploration, and that this should be the case in even very young children. To investigate this, we compared children's responses to information acquired either socially or from personal experience. The task we used allowed direct comparison between these alternative information sources, as the information value was equivalent across conditions, which has not been true of previous methods used to tackle similar questions. Across two 18-month- to 5-year-old samples (recruited in the United Kingdom and China), we found that children performed similarly following information acquired from social demonstrations, compared with personal experience. Children's use of the information thus appeared independent of source. Furthermore, children's suboptimal performance showed evidence of a consistent bias driven by motivation for exploration as well as exploitation, which was apparent across both conditions and in both samples. Our results are consistent with the view that apparent peculiarities identified in human social information use could be developmental outcomes of general-purpose learning and motivational biases, as opposed to mechanisms that have been biologically selected specifically for the acquisition of cultural information. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Improving preprocedure antithrombotic management: Implementation and sustainment of a best practice alert and pharmacist referral process.

BACKGROUND: Electronic medical record-based interventions such as best practice alerts, or reminders, have been proposed to improve evidence-based medication prescribing. Formal implementation evaluation including long-term sustainment are not commonly reported. Preprocedural medication management is often a complex issue for patients taking antithrombotic medications. METHODS: We implemented a best practice alert (BPA) that recommended referral to an anticoagulation clinic before outpatient elective gastrointestinal (GI) endoscopies. Eligible patients were taking an oral anticoagulant (warfarin or direct oral anticoagulant [DOAC]) and/or antiplatelet medications. Patients referred to the anticoagulation clinic were compared to those managed by the ordering provider. Outcomes assessed included guideline-adherent drug management before endoscopy, documentation of a medication management plan, guideline-adherent rates of bridging for high-risk patients taking warfarin, and evaluation for sustained use of BPA. RESULTS: Eighty percent of patients (553/691) were referred to the anticoagulation clinic during the initial 13-month study period. Most referrals came from gastroenterologists (397/553; 71.8%) followed by primary care providers (127/554; 22.9%). Patients referred had improved rates of guideline-adherent medication management compared to those who were not referred (97.4% vs 91.0%; P = .001). Documentation of medication plan was significantly higher in the referred group (99.1% vs 59.4%; P ≤ .001). There were no differences in rates of appropriate bridging for patients taking warfarin. Implementation of the BPA also resulted in sustained, consistent use over an additional 18 months following the initial study period. CONCLUSION: Implementation of a BPA before elective outpatient GI endoscopies was associated with improved rates of guideline-adherent medication management and documented management plan, while streamlining preprocedural medication management.

Development of strategic social information seeking: Implications for cumulative culture.

Human learners are rarely the passive recipients of valuable social information. Rather, learners usually have to actively seek out information from a variety of potential others to determine who is in a position to provide useful information. Yet, the majority of developmental social learning paradigms do not address participants' ability to seek out information for themselves. To investigate age-related changes in children's ability to seek out appropriate social information, 3- to 8-year-olds (N = 218) were presented with a task requiring them to identify which of four possible demonstrators could provide critical information for unlocking a box. Appropriate information seeking improved significantly with age. The particularly high performance of 7- and 8-year-olds was consistent with the expectation that older children's increased metacognitive understanding would allow them to identify appropriate information sources. Appropriate social information seeking may have been overlooked as a significant cognitive challenge involved in fully benefiting from others' knowledge, potentially influencing understanding of the phylogenetic distribution of cumulative culture.

Management of anticoagulation in patients with human immunodeficiency virus/acquired immunodeficiency virus.

PURPOSE: Limited guidance is available to assist practitioners in managing complex human immunodeficiency virus (HIV) related pharmacotherapy. Management recommendations of oral anticoagulation (warfarin and direct oral anticoagulants [DOACs]) and highly active antiretroviral therapy (HAART) based on drug-drug interactions (DDI) studies and pharmacokinetic (PK) data are provided. METHODS: Search of PubMed, EMBASE, and Google Scholar (01/1985 to 12/2018) using the terms "HIV," "DDI," and names of HAART. PK information and DDI screening were obtained from medication package inserts and drug information resources: Micromedex, Lexicomp, HIV-DDI Checker- University of Liverpool. All English literature on DDI or PK interactions was considered for inclusion. In the absence of data, PK principles were used to predict the likelihood of interactions. RESULTS: No clinically significant DDI are expected to occur between DOACs and nucleoside or nucleotide reverse transcriptase inhibitors (NRTIs), maraviroc, enfuvirtide, or integrase strand inhibitors (INSTIs) that do not include a pharmacologic booster. Potent cytochrome P (CYP) 450 enzyme inhibition by protease inhibitors (PIs) or pharmacologic boosters may lead to higher concentrations of the DOAC and potentially increase the risk of bleeding. CYP450 enzyme induction by non-nucleoside reverse transcriptase inhibitors (NNRTIs) may lower concentrations of DOACs, which may lead to treatment failure. Warfarin DDIs are variable, therefore close monitoring of the INR is recommended. CONCLUSIONS: The potential for DDIs between HAART and oral anticoagulation exists based on PK profiles. Management of these interactions should involve careful selection based on patient characteristics and HAART and anticoagulants with a low potential for DDI should be selected.