Direct oral anticoagulants that specifically inhibit thrombin and factor Xa are now available. These agents would not be suitable for all patients, particularly if drug interactions with potential antiviral medication are expected, or in mechanically ventilated patients requiring enteral feeding. Although rivaroxaban and apixaban can be delivered via a nasogastric tube to the stomach, they should not be mixed with enteral nutrition [101]. As with LMWH there is an increased risk of bleeding with direct oral anticoagulants but in COVID-19, complications related to bleeding are anecdotally not commonly seen, but a recent study has suggested an increased risk of bleeding in non-critically ill patients receiving heparin [102]. Hence the risk of bleeding complications may be lower for patients at increased risk of death with COVID-19 compared to other causes of severe sepsis/ARDS. Furthermore, idarucizumab and andexanet alfa are now available for the reversal of dabigatran and rivaroxaban/apixaban, respectively, mitigating the fear that the effects of these agents cannot be reversed should bleeding occur.