New oral anticoagulants

The quest for finding an ideal anticoagulant that can replace the commonly used VKA (warfarin) continues. There is now a plethora of data regarding the safety and efficacy of newer oral anticoagulants (NOAC) compared to warfarin for wide ranging clinical indications. These NOACs fall into 2 distinct categories due to their specific targeted action - Factor Xa Inhibitors and Thrombin Inhibitors. Rivaroxaban, Apixaban and Edoxaban belong to the group of Factor Xa Inhibitors while Dabigatran remain the sole Thrombin Inhibitor. In this review I have tried to explain many of the properties of an ideal anticoagulant that these NOACs possess. I have also discussed about some of the emerging antidotes for these NOACS. The detail analysis of all the available evidence comprising of nearly 50,000 patients in different clinical indications suggest that the NOACs are not inferior to VKA (warfarin)with regard to their efficacy but superior with regard to their safety profile.