Postgrad Med J 90:529-539 doi:10.1136/postgradmedj-2013-132474
  • Review

Direct oral anticoagulants: integration into clinical practice

Open Access
  1. Richard P W Cowell
  1. Correspondence to Dr Richard Cowell, Department of Cardiology, Wrexham Maelor Hospital, Croesnewydd Road, Wrexham, LL13 7TD, UK; richard.cowell{at}
  • Received 4 November 2013
  • Accepted 3 June 2014
  • Published Online First 10 July 2014


The introduction of direct oral anticoagulants (OACs) for the treatment and prevention of thromboembolic disease represents a shift from the traditional vitamin K antagonist-based therapies, which have been the mainstay of treatment for almost 60 years. A challenge for hospital formularies will be to manage the use of direct OACs from hospital to outpatient settings. Three direct OACs—apixaban, dabigatran and rivaroxaban—are widely approved across different indications, with rivaroxaban approved across the widest breadth of indications. A fourth direct OAC, edoxaban, has also completed phase III trials. Implementation of these agents by physicians will require an understanding of the efficacy and safety profile of these drugs, as well as an awareness of renal function, comedication use, patient adherence and compliance. Optimal implementation of direct OACs in the hospital setting will provide improved patient outcomes when compared with traditional anticoagulants and will simplify the treatment and prevention of thromboembolic diseases.

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