Although direct oral anticoagulants (DOACs) have transformed stroke prevention in atrial fibrillation, treatment switches are frequently necessitated by changes in clinical status, bleeding risk, tolerability, drug interactions, cost, or adherence. This session will explore the clinical rationale, evidence, and practical considerations for switching between DOACs, offering a structured approach to optimizing anticoagulation while maintaining efficacy, minimizing bleeding risk, and addressing real-world barriers to long-term treatment.