Changing practice of anticoagulation: will target-specific anticoagulants replace warfarin?

Area of Science:

• Pharmacology
• Cardiovascular Medicine
• Hematology

Background:

• Target-specific oral anticoagulants (TSOACs) inhibit factor Xa or thrombin.
• Warfarin, a vitamin K antagonist, is a traditional anticoagulant.
• Low-molecular-weight heparin (LMWH) is used for thromboprophylaxis.

Purpose of the Study:

• To compare the efficacy and safety of TSOACs with warfarin and LMWH.
• To evaluate the current and future role of TSOACs in various clinical indications.
• To identify limitations and areas for further research regarding TSOACs.

Main Methods:

• Review of clinical studies comparing TSOACs with warfarin and LMWH.
• Analysis of TSOACs' effectiveness in atrial fibrillation, venous thromboembolism, and post-arthroplasty prophylaxis.
• Assessment of TSOACs' performance in specific patient groups and for particular indications.

Main Results:

• TSOACs are effective and safe for stroke prevention in atrial fibrillation and VTE treatment, comparable to LMWH for post-arthroplasty prophylaxis.
• Warfarin remains the anticoagulant of choice for stroke prevention in patients with mechanical heart valves.
• Unfavorable initial studies exist for TSOACs in mechanical heart valves, cancer-associated thrombosis, and heparin-induced thrombocytopenia.

Conclusions:

• TSOACs offer advantages in certain indications, but warfarin's role persists.
• Further research is essential for TSOACs in complex cases like cancer-associated thrombosis and heparin-induced thrombocytopenia.
• Challenges in laboratory monitoring and lack of specific reversal agents necessitate continued use of vitamin K antagonists.