Direct acting oral anticoagulants (DOACs) have grown in popularity since 2010 with Food and Drug Administration (FDA) approval of the direct thrombin inhibitor, dabigatran. Direct factor Xa inhibitors such as edoxaban, apixaban, and rivaroxaban were subsequently approved. All DOACs have FDA-approved indications for stroke prophylaxis for nonvalvular atrial fibrillation, and prophylaxis and treatment for venous thromboembolism (VTE). Dabigatran, apixaban, and rivaroxaban have an additional indication for VTE prophylaxis in total hip arthroplasty. Furthermore, apixaban and rivaroxaban are also indicated for VTE prophylaxis in total knee arthroplasty. With fixed dosing, rivaroxaban, in combination with low-dose aspirin, is indicated for risk reduction of major cardiovascular event (eg, cardiovascular death, myocardial infarction, and stroke) in patients with chronic coronary artery disease or peripheral artery disease. 1-4 With fixed dosing regimens and no required laboratory monitoring, DOACs make antithrombotic therapy more convenient for both providers and patients compared with warfarin. DOACs also have fewer drug interactions and are associated with reduced risk of bleeding compared 839437P MTXXX10.
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