Abstract
Direct (New-generation) Oral Anticoagulants (DOACs) have emerged as effective
agents which are used in place of vitamin-K antagonists in treatment and prophylaxis of Venous
Thromboembolism (VTE), atrial fibrillation and other thrombotic diseases. Among them, the FIIa-
direct thrombin inhibitor dabigatran and FXa inhibitors (rivaroxaban, apixaban, edoxaban) are
the most broadly used. Anticoagulant dosing may differ under special considerations. The patients’
physiological reserves, organ functional status and failures should be taken into account in clinical
decision-making processes. The advantages and drawbacks of each specific agent should be
weighed with special regard to metabolism, pharmacokinetics and pharmacodynamics, along with
the efficiency of the agents in different indications. This article aims to review the most recent literature
to highlight the usage and efficacy of the agents in different clinical conditions.
Keywords:
Direct oral anticoagulants, new oral anticoagulants, anticoagulation, venous thromboembolism, thrombosis, thromboembolic disease.
Graphical Abstract
[9]
Guyatt, G.H.; Akl, E.A.; Crowther, M. Executive summary: Antithrombotic therapy and prevention of thrombosis: American College of Chest Physicians evidence-based clinical practice guidelines. Chest, 2012, 141(2 Suppl), 7-47.
[22]
Eikelboom, J.W.; Connolly, S.J.; Bosch, J.; Dagenais, G.R.; Hart, R.G.; Shestakovska, O.; Diaz, R.; Alings, M.; Lonn, E.M.; Anand, S.S.; Widimsky, P.; Hori, M.; Avezum, A.; Piegas, L.S.; Branch, K.R.H.; Probstfield, J.; Bhatt, D.L.; Zhu, J.; Liang, Y.; Maggioni, A.P.; Lopez-Jaramillo, P.; O’Donnell, M.; Kakkar, A.K.; Fox, K.A.A.; Parkhomenko, A.N.; Ertl, G.; Störk, S.; Keltai, M.; Ryden, L.; Pogosova, N.; Dans, A.L.; Lanas, F.; Commerford, P.J.; Torp-Pedersen, C.; Guzik, T.J.; Verhamme, P.B.; Vinereanu, D.; Kim, J.H.; Tonkin, A.M.; Lewis, B.S.; Felix, C.; Yusoff, K.; Steg, P.G.; Metsarinne, K.P.; Cook Bruns, N.; Misselwitz, F.; Chen, E.; Leong, D.; Yusuf, S. COMPASS Investigators. Rivaroxaban with or without aspirin in stable cardiovascular disease.
N. Engl. J. Med., 2017,
377(14), 1319-1330.
[
http://dx.doi.org/10.1056/NEJMoa1709118] [PMID:
28844192]
[25]
Eikelboom, J.W.; Connolly, S.J.; Bosch, J.; Dagenais, G.R.; Hart, R.G.; Shestakovska, O.; Diaz, R.; Alings, M.; Lonn, E.M.; Anand, S.S.; Widimsky, P.; Hori, M.; Avezum, A.; Piegas, L.S.; Branch, K.R.H.; Probstfield, J.; Bhatt, D.L.; Zhu, J.; Liang, Y.; Maggioni, A.P.; Lopez-Jaramillo, P.; O’Donnell, M.; Kakkar, A.K.; Fox, K.A.A.; Parkhomenko, A.N.; Ertl, G.; Störk, S.; Keltai, M.; Ryden, L.; Pogosova, N.; Dans, A.L.; Lanas, F.; Commerford, P.J.; Torp-Pedersen, C.; Guzik, T.J.; Verhamme, P.B.; Vinereanu, D.; Kim, J.H.; Tonkin, A.M.; Lewis, B.S.; Felix, C.; Yusoff, K.; Steg, P.G.; Metsarinne, K.P.; Cook Bruns, N.; Misselwitz, F.; Chen, E.; Leong, D.; Yusuf, S. COMPASS investigators. Rivaroxaban with or without aspirin in stable cardiovascular disease.
N. Engl. J. Med., 2017,
377(14), 1319-1330.
[
http://dx.doi.org/10.1056/NEJMoa1709118] [PMID:
28844192]