Overview of the Direct Oral Anticoagulants

Over the past 6 decades, warfarin has proven efficacious in reducing stroke risk in patients with atrial fibrillation and reducing the risk of recurrent venous thromboembolism in patients with acute deep vein thrombosis or pulmonary embolism. However, there have been multiple challenges with using warfarin including delayed onset of action, need for bridging and monitoring as well as many drug-drug and drug-food interactions. Hence, long years of research have led to the development of direct oral anticoagulants. Of the 4 direct oral anticoagulants currently approved by the Food and Drug Administration, 1 is a direct thrombin inhibitor (dabigatran) and the other 3 are direct factor Xa inhibitors (apixaban, rivaroxaban and edoxaban). Direct oral anticoagulants have been found to be at least as effective as warfarin with fewer bleeding complications. This paper provides an overview of the evolution of anticoagulation therapies and an extensive literature review of the new direct oral anticoagulants.