Use of direct oral anticoagulants in clinical practice

Abstract

Direct oral anticoagulants arose in response to the search for an ideal anticoagulant, after warfarin was, for a long time, the only available oral anticoagulant. Factor Xa inhibitors —rivaroxaban and apixaban— and thrombin inhibitor —dabigatran etexilate— are already approved in Colombia. These pharmacological sets are warranted for thromboprophylaxis after hip and knee arthroplasty, prevention of stroke and systemic embolism in patients with atrial fibrillation and in the treatment of venous thromboembolism. The approval of these medicines came after showing their efficacy and safety compared with warfarin and enoxaparin. Some of the advantages offered by them include: rapid onset of action; predictable effect, low interindividual variability that eliminates the necessity of frequent monitoring; and fewer drug interactions. Somehow, similar to warfarin, bleeding is the major adverse event. The objective of this review is to acknowledge pharmacology of the direct oral anticoagulants, results of clinical trials supporting its use, dosage, perioperative management and switching between anticoagulants; conditions that create specific scenarios for each one of these drugs.