Direct-acting oral anticoagulants: pharmacology, indications, management, and future perspectives.

摘要: In recent years, several direct-acting oral anticoagulants (DOAC) have become available for use in Europe and other regions indications related to prophylaxis treatment of venous arterial thromboembolism. They include the direct thrombin inhibitor dabigatran etexilate (Pradaxa, Boehringer Ingelheim) FXa inhibitors rivaroxaban (Xarelto, Bayer HealthCare), apixaban (Eliquis, Bristol-Myers Squibb), edoxaban (Lixiana/Savaysa, Daiichi-Sankyo). The new compounds a predictable dose response few drug-drug interactions (unlike vitamin k antagonists), they do not require parenteral administration heparins). However, accumulate patients with renal impairment, lack widely monitoring tests measuring its anticoagulant activity, no specific antidotes neutralization case overdose and/or severe bleeding are currently available. this review, we describe pharmacology DOAC, efficacy, safety data from pivotal studies that support their approved discuss postmarketing experience We also summarize practical recommendations ensure an appropriate DOAC according existing data. Finally, relevant ongoing future perspectives.