Oral anticoagulants: Optimizing venous thromboembolism management

Abstract

A decade ago, oral anticoagulants were limited to Vitamin K antagonists, i.e., warfarin. Since 2010, the US Food and Drug Administration has approved several non-Vitamin K oral anticoagulants: dabigatran is a direct thrombin inhibitor, while apixaban, edoxaban, and rivaroxaban are direct factor Xa inhibitors. Oral anticoagulants are used for the management of several venous thromboembolism (VTE) events, including the prevention of stroke in nonvalvular atrial fibrillation; acute coronary syndromes; treatment of VTE; and VTE prophylaxis after total hip or knee replacement. In this review article, we address the main indications, dosages, bleeding and reversal agents, pharmacokinetic and pharmacodynamic properties, and methods of switching between oral anticoagulants.

Keywords

• anticoagulants
• bleeding
• management
• reversal agent
• venous thromboembolism