Abstract
After the introduction of warfarin, long-term oral anticoagulation treatment remained
unchanged for more than 50 years. Most recently, with the development and approval
of new oral anticoagulants, the treatment of medical conditions that require thrombosis
prophylaxis and long-term anticoagulation has become more complex. In the case of
venous thromboembolism (VTE) prevention after orthopedic surgery, the new oral agents
will be less costly than the parenteral alternative. In other settings (such as atrial
fibrillation or treatment of acute VTE), the new agents will offer additional convenience
at higher cost, but the degree to which they will reduce clinically important events
such as thrombosis or bleeding will be limited, especially for patients on optimally
controlled warfarin. As the use of the new oral anticoagulants becomes more widespread,
it will be important for all clinicians to have a basic understanding of their pharmacology,
advantages, and limitations. Although the need to measure or reverse the effect of
these drugs will arise infrequently, clinicians—especially hematologists—will desire
evidence-based recommendations about how to manage such scenarios, which will require
research studies.
Keywords
anticoagulants - oral anticoagulants - apixaban - rivaroxaban - dabigatran
