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Annual Review of Pharmacology and Toxicology

Volume 64, 2024

Oral Anticoagulants Beyond Warfarin

Abstract

Direct oral anticoagulants (DOACs) have largely replaced vitamin K antagonists, mostly warfarin, for the main indications for oral anticoagulation, prevention and treatment of venous thromboembolism, and prevention of embolic stroke in atrial fibrillation. While DOACs offer practical, fixed-dose anticoagulation in many patients, specific restrictions or contraindications may apply. DOACs are not sufficiently effective in high–thrombotic risk conditions such as antiphospholipid syndrome and mechanical heart valves. Patients with cancer-associated thrombosis may benefit from DOACs, but the bleeding risk, particularly in those with gastrointestinal or urogenital tumors, must be carefully weighed. In patients with frailty, excess body weight, and/or moderate-to-severe chronic kidney disease, DOACs must be cautiously administered and may require laboratory monitoring. Reversal agents have been developed and approved for life-threatening bleeding. In addition, the clinical testing of potentially safer anticoagulants such as factor XI(a) inhibitors is important to further optimize anticoagulant therapy in an increasingly elderly and frail population worldwide.

Keyword(s): antiplatelet agents, atrial fibrillation, bleeding, cancer-associated thrombosis, chronic kidney disease, direct oral anticoagulants, drug interactions, factor XI inhibitors, reversal agents, venous thromboembolism
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2024-01-23
2024-04-27
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Oral Anticoagulants Beyond Warfarin
Annual Review of Pharmacology and Toxicology 64, 551 (2024); https://doi.org/10.1146/annurev-pharmtox-032823-122811
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