Anticoagulation in venous thromboembolism and in atrial fibrillation

Atrial fibrillation and venous thromboembolism cause significant morbidity and mortality worldwide. Therefore, anticoagulation therapy (even chronic) is mandatory for the broad majority of affected persons. Warfarin therapy has been, for decades, the best oral anticoagulant alternative for venous thromboembolism, as well as for stroke prevention in atrial fibrillation. However, modern oral direct oral anticoagulants (DOACs) are consolidated drugs for these purposes with well-designed pivotal randomized clinical trials, and with long data bases of clinical posterior experience which demonstrate better efficacy, safety, or both than warfarin. However, since DOACs also present some limitations, there are diverse emergent agents and strategies in anticoagulation. This manuscript reviews the available anticoagulation strategies for both clinical entities and presents new rational therapeutic targets in the hemostatic system.