New oral anticoagulant agents after ACS

Despite tremendous progress in the management of patients with an acute coronary syndrome (ACS), morbidity and mortality remains high even in stable patients after discharge. The benefit of adding vitamin K antagonists (VKA) on top of antiplatelet therapy to prevent recurrent ischaemic events after an ACS has been successfully studied in the past. Because of their need for frequent monitoring and drug and food interactions, however, systematic long-term use of VKA has not been recommended in this setting. The new oral anticoagulants offer several advantages compared to VKA, including a faster onset and offset of action and the absence of frequent monitoring. In this review, we evaluate the current evidence and practical consequences of using the oral direct thrombin inhibitor dabigatran or the oral anti factor Xa inhibitors apixaban, rivaroxaban, and darexaban in stable ACS patients.