Updates on Direct Oral Anticoagulants in the Management of Atrial Fibrillation

irect thrombin inhibitor (dabigatran) and factor Xa inhibitors (apixaban, edoxaban, rivaroxaban) have been established as safe and effective alternatives to warfarin for stroke prevention in patients with non-valvular atrial fibrillation (AF).Direct oral anticoagulants (DOACs) have gained popularity since becoming available on the market, due to their lack of need for laboratory monitoring and relatively few drug and food interactions.However, while warfarin has extensive clinical evidence supporting its use in AF patient populations with various comorbidities, there is limited evidence in the use of DOACs in many AF patient subpopulations.Results available to date suggested that DOACs are generally well tolerated across a wide spectrum of patients with AF, including those with renal dysfunction and valvular heart disease.The use of DOACs in patients with a mechanical heart valve is not recommended due to increased risk of thromboembolic events.In patients with AF and coronary stents, the use of DOACs in addition to dual antiplatelet therapy increase bleeding.However, removal of aspirin from the regimen appeared to maintain equivalent efficacy for preventing cardiovascular events without increased risk of bleeding.Furthermore, DOACs can be safely used in peri-cardioversion and peri-catheter ablation to prevent thromboembolic events.Reversal agents are now available should major bleeding occur; this will continue to expand the use of DOACs.Future research will continue to explore the use of DOACs in other AF special populations, such as pregnancy, and in other coagulation disorders, where warfarin is the current preferred agent.