Safety and optimal use of direct oral anticoagulant therapy

INTRODUCTION: The landscape of oral anticoagulant (OAC) treatment dramatically changed with the introduction into clinical practice of the direct oral anticoagulants (DOACs), which have been able to overcome major limitations of vitamin K antagonists. AREAS COVERED: This review summarizes the pharmacokinetic and pharmacodynamic profiles of commercially available DOACs (apixaban, rivaroxaban, dabigatran, and edoxaban), as well as their efficacy and safety in the settings of atrial fibrillation, venous thromboembolism, prevention of cancer-associated thrombotic events, and atherosclerotic disease. Limitations of commercially available DOACs are also reviewed. EXPERT OPINION: The introduction into clinical practice of DOACs has significantly changed the landscape of OAC, given their favorable safety and efficacy profiles. However, there are still several unmet needs for patients requiring treatment with OAC, underscoring the need for further research in the field to optimize the safety and efficacy of these agents across different clinical settings.