The evolution of oral anticoagulant therapy

Before the advent of oral, targeted anticoagulants, physicians had no choice regarding the type of oral anticoagulant prescribed, as every patient received warfarin. The new oral direct thrombin and factor Xa inhibitors give the prescribing physician, as well as the patient, greater choice. Variation in dosing, half-life, elimination, monitoring, and reversal will help the clinician decide on the appropriate anticoagulant for the appropriate patient. Rather than replace warfarin, each anticoagulant will now have a particular niche, and the decision of which agent to prescribe will be determined at the bedside.