Oral anticoagulant therapy: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines.
BACKGROUND
The objective of this article is to summarize the published literature concerning the pharmacokinetics and pharmacodynamics of oral anticoagulant drugs that are currently available for clinical use and other aspects related to their management.


METHODS
We carried out a standard review of published articles focusing on the laboratory and clinical characteristics of the vitamin K antagonists; the direct thrombin inhibitor, dabigatran etexilate; and the direct factor Xa inhibitor, rivaroxaban


RESULTS
The antithrombotic effect of each oral anticoagulant drug, the interactions, and the monitoring of anticoagulation intensity are described in detail and discussed without providing specific recommendations. Moreover, we describe and discuss the clinical applications and optimal dosages of oral anticoagulant therapies, practical issues related to their initiation and monitoring, adverse events such as bleeding and other potential side effects, and available strategies for reversal.


CONCLUSIONS
There is a large amount of evidence on laboratory and clinical characteristics of vitamin K antagonists. A growing body of evidence is becoming available on the first new oral anticoagulant drugs available for clinical use, dabigatran and rivaroxaban.
University of Insubria, Varese, Italy. Electronic address: walter.ageno@uninsubria.it.
Walter
W
Ageno
Flinders University, Adelaide, SA, Australia.
Alexander S
AS
Gallus
University of Washington, Seattle, WA, Canada.
Ann
A
Wittkowsky
McMaster University, St. Joseph's Hospital, Hamilton, ON, Canada.
Mark
M
Crowther
Boston University School of Medicine, Boston, MA.
Elaine M
EM
Hylek
University Hospital S. Orsola-Malpighi, Bologna, Italy.
Gualtiero
G
Palareti
D000284:Administration, Oral; D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects / Q000493:pharmacokinetics; D000991:Antithrombins / Q000008:administration & dosage / Q000009:adverse effects / Q000493:pharmacokinetics; D001562:Benzimidazoles / Q000008:administration & dosage / Q000009:adverse effects / Q000493:pharmacokinetics; D000069604:Dabigatran; D004305:Dose-Response Relationship, Drug; D019317:Evidence-Based Medicine; D015951:Factor Xa / Q000378:metabolism; D065427:Factor Xa Inhibitors; D006801:Humans; D009025:Morpholines / Q000008:administration & dosage / Q000009:adverse effects / Q000493:pharmacokinetics; D017410:Practice Guidelines as Topic; D011725:Pyridines / Q000008:administration & dosage / Q000009:adverse effects / Q000493:pharmacokinetics; D000069552:Rivaroxaban; D012955:Societies, Medical; D013876:Thiophenes / Q000008:administration & dosage / Q000009:adverse effects / Q000493:pharmacokinetics; D013927:Thrombosis / Q000097:blood / Q000188:drug therapy* / Q000517:prevention & control*; D014481:United States; D014812:Vitamin K / Q000037:antagonists & inhibitors / Q000097:blood
D000925:Anticoagulants; D000991:Antithrombins; D001562:Benzimidazoles; D065427:Factor Xa Inhibitors; D009025:Morpholines; D011725:Pyridines; D013876:Thiophenes; D014812:Vitamin K; D000069552:Rivaroxaban; D015951:Factor Xa; D000069604:Dabigatran