Direct Oral Anticoagulants: From Randomized Clinical Trials to Real-World Clinical Practice

Area of Science:

• Pharmacology and Clinical Medicine
• Cardiovascular Thrombosis
• Anticoagulant Therapy

Background:

• Direct oral anticoagulants (DOACs) are increasingly used for stroke prevention in nonvalvular atrial fibrillation and venous thromboembolism (VTE).
• Optimizing DOAC use in specific clinical scenarios remains an area of active investigation.

Purpose of the Study:

• To review current clinical evidence on DOACs, covering pharmacology, indications, safety, and practical management issues.
• To highlight drug-food interactions, perioperative management, bleeding treatment, and use in special populations.

Main Methods:

• Comprehensive review of existing clinical evidence on direct oral anticoagulants.
• Analysis of pharmacokinetic profiles, clinical trial data, and real-world evidence.

Main Results:

• DOACs demonstrate comparable or superior efficacy to vitamin K antagonists (VKAs) with a favorable safety profile.
• Dabigatran shows the most drug-food interactions, though all DOACs have good pharmacokinetic profiles.
• Encouraging data exists for low-dose edoxaban in elderly patients and edoxaban/rivaroxaban in VTE for oncologic patients.

Conclusions:

• DOACs are effective and safe alternatives to VKAs, with evidence supporting their use in diverse patient groups.
• Further expansion of DOAC clinical indications is anticipated.
• Careful consideration of drug interactions and special populations is crucial for optimal DOAC management.