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Background and Importance Direct oral anticoagulants (DOACs) are widely prescribed in various clinical settings.Their potential to interact with other drugs is a significant concern. Multiple druginteraction databases are consulted in clinical practice, though agreement between themin classifying DOAC interactions is largely unknown.Aim and Objectives To assess inter-database agreement in the classification of interaction severity for each DOAC.Material and Methods A cross-sectional observational study was conducted using four drug interaction databases (Lexicomp, Medinteract, Micromedex, and Drugs.com). All interactions for apixaban, dabigatran, edoxaban, and rivaroxaban were retrieved. Severity ratings from each database were harmonised into four categories: Clasification Lexicomp Medinteract Micromedex Drugs.com Severe X, D Grave Contraindicated, Major Major Moderate C Moderada Moderate Moderate Minor B Leve Minor Minor Undetermined A No determinado - Unknown Agreement was assessed at two levels: global (four databases) using Gwet’s AC (quadratic weights) with Fleiss’ Kappa as sensitivity, and pairwise using Cohen’s Kappa. Interpretation followed Altman’s thresholds: ≤0.20 poor, 0.21–0.40 fair, 0.41–0.60 moderate, 0.61–0.80 good, 0.81–1.00 excellent agreement.Results A total of 1,992 drug interactions were analysed: apixaban 531 (26.7%), dabigatran 492 (24.7%), edoxaban 411 (20.6%), rivaroxaban 558 (28.0%). Agreement coefficients by DOAC were:Apixaban: Gwet’s AC = 0.29, Fleiss’ Kappa = 0.17.Dabigatran: Gwet’s AC = 0.17, Fleiss’ Kappa = 0.15.Edoxaban: Gwet’s AC = 0.15, Fleiss’ Kappa = 0.11.Rivaroxaban: Gwet’s AC = 0.28, Fleiss’ Kappa = 0.15.Apixaban and rivaroxaban had slightly higher agreement values, but all results remained between the ‘poor’ and ‘fair’ range.Abstract 5PSQ-024 Table 1 ACOD Lexicomp vs Medinteract Lexicomp vs Micromedex Lexicomp vs Drugs.com Medinteract vs Drugs.com Medinteract vs Micromedex Micromedex vs Drugs.com Apixaban 0.27 0.39 0.11 0.07 0.24 0.12 Dabigatran 0.11 0.18 0.25 0.16 0.15 0.14 Edoxaban 0.22 0.14 0.11 0.10 0.22 0.00 Rivaroxaban 0.23 0.32 0.11 0.10 0.17 0.12 Conclusion and Relevance Agreement between drug interaction databases for DOACs is consistently poor, regardless of weighting method, with minimal variation among agents. Slightly higher concordance for apixaban and rivaroxaban suggests more consistent evidence or criteria for these drugs, while dabigatran and edoxaban showed the lowest agreement. Clinicians should consult multiple sources when evaluating DOAC interactions, and efforts to standardise classification systems could enhance consistency and patient safety.Conflict of Interest No conflict of interest