Direct Oral Anticoagulants: A Patient-centered Review

• Warfarin has been the standard anticoagulant for treating venous thromboembolism and for preventing stroke in atrial fibrillation
• The safe use of warfarin is challenging, especially for older patients.
• Since 2010, 4 new oral anticoagulants have been approved for venous thromboembolism, atrial fibrillation, and prophylaxis after joint replacement surgery.
• Newly released guidelines by The American College of Chest Physicians (CHEST) are expected to increase direct oral anticoagulant prescribing.
• Although major studies of atrial fibrillation and venous thromboembolism have shown non-inferiority of the newer anticoagulants compared with warfarin, important limitations in these trials exist.

Since 2010, 4 new oral anticoagulants have been approved by the Food and Drug Administration with additional drugs in development. Major studies of atrial fibrillation and venous thromboembolism have shown the noninferiority, and the potential superiority, of these anticoagulants compared with warfarin. However, important limitations exist in these studies including suboptimal warfarin management and the inclusion of few participants with significant chronic kidney disease and concomitant drug therapy. The new oral anticoagulants offer both advantages and disadvantages over standard warfarin therapy.