Related Experiment Video
Updated: Aug 22, 2025
Rapid Point-of-Care Assay of Enoxaparin Anticoagulant Efficacy in Whole Blood
Published on: October 12, 2012
Direct oral anticoagulant: Review article
Abdulrahman Nasiri1, Ahmed AlQahtani1, Nora H Rayes2
1Department of Internal Medicine, Security Forces Hospital (SFH), Riyadh, Saudi Arabia.
Insights
Direct oral anticoagulants (DOACs) are now the leading treatment for stroke prevention in atrial fibrillation (AF) and venous thromboembolism (VTE). This overview covers DOACs
Area of Science:
- Cardiology
- Hematology
- Pharmacology
Background:
- Venous thromboembolism (VTE) and atrial fibrillation (AF) pose significant healthcare challenges.
- Vitamin K antagonists (VKAs) were historically used but require careful monitoring (INR) due to interactions and liver issues, leading to risks of undertreatment or overtreatment.
- Direct oral anticoagulants (DOACs) have emerged as a transformative treatment for coagulation disorders.
Purpose of the Study:
- To provide a comprehensive overview of direct oral anticoagulants (DOACs).
- To discuss DOAC indications, use in specific comorbidities, and monitoring.
- To cover perioperative management and reversal agents for DOACs.
Main Methods:
- Literature review of DOACs.
- Analysis of clinical guidelines and studies on DOACs.
- Synthesis of information on DOAC management.
Main Results:
- DOACs are the leading treatment for stroke prevention in AF and VTE prophylaxis/treatment.
- Challenges with VKA therapy include maintaining therapeutic INR, drug/food interactions, and liver disorders.
- DOACs offer an alternative with distinct management considerations.
Conclusions:
- DOACs represent a significant advancement in managing AF and VTE.
- Understanding DOAC indications, management, and reversal is crucial for effective patient care.
- This overview serves as a guide for clinicians using DOACs.
Abstract:
Venous thromboembolism (VTE) and atrial fibrillation (AF) is a major burden on the health care system. The average occurrence of venous thromboembolism annually is around 108 per 100,000 person-year. DOACs have transformed treatment of coagulation disorder, and now, it is the leading treatment for stroke prevention in AF and VTE prophylaxis and treatment. For more many years, oral vitamin K antagonists (VKAs) were the drug of choice in managing VTE. VKAs treatment is safe and effective if therapeutic international normalized ratio (INR) maintained on the target. However, achieving a stable, therapeutic international normalized ratio (INR) can be difficult and challenging in the context of drug and food interactions and liver disorder, resulting in undertreatment which increases the risk of thromboembolism or overtreatment which might cause bleeding. Herein, we provide an overview of DOACs indications, use in specific comorbidities, monitoring parameters, perioperative management, and reversal agents.
