Direct Oral Anticoagulants (DOACs) in 2025: –
Apixaban (Factor Xa inhibitor) –
Rivaroxaban (Factor Xa inhibitor) –
Edoxaban(Factor Xa inhibitor)
Dabigatran (Direct thrombin inhibitor) –
Betrixaban (Factor Xa inhibitor, approved for extended VTE prophylaxis)
Apixaban (Eliquis)–
Onset: Rapid, with peak plasma concentrations reached in 3–4 hours. –
Action: Direct factor Xa inhibitor, preventing clot formation. –
Side Effects: – Bleeding (most common, including gastrointestinal and intracranial). – Nausea, dizziness. –
Rare: Hepatic impairment, allergic reactions. –
Rationale: Apixaban is well-absorbed orally and has a predictable response, making it suitable for many patients. –
Rivaroxaban (Xarelto) –
Onset: Rapid, with peak plasma concentrations in 2–4 hours. –
Action: Direct factor Xa inhibitor, similar to apixaban. –
Side Effects: – Bleeding (gastrointestinal, intracranial). – Liver enzyme elevation. –
Rare: Skin rash, pruritus. –
Rationale: Rivaroxaban is dosed once daily, which may improve adherence. –
Dabigatran (Pradaxa) –
Onset: Rapid, with peak plasma concentrations in 2–3 hours. –
Action: Direct thrombin inhibitor, blocking clot formation. –
Side Effects: – Bleeding (gastrointestinal, rarely intracranial). – Dyspepsia, abdominal pain. –
Rare: Myocardial infarction (controversial). –
Rationale: Dabigatran requires twice-daily dosing, which may be a drawback for some patients. –
Edoxaban (Savaysa) –
Onset: Rapid, with peak plasma concentrations in 1–2 hours. –
Action: Direct factor Xa inhibitor, similar to apixaban and rivaroxaban. – Anemia, fatigue. – Rare: Elevated liver enzymes. –
Rationale: Edoxaban has a lower risk of gastrointestinal bleeding compared to rivaroxaban.
Key Considerations: – All DOACs require dose adjustments for renal impairment. –
No specific antidotes for most DOACs, but idarucizumab is available for dabigatran. –
Monitoring is not required, unlike warfarin, but adherence is critical.