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Direct oral anticoagulants and parenteral direct thrombin inhibitors: Dosing and adverse effects

Lawrence LK Leung, MD
Section Editor
Pier Mannuccio Mannucci, MD
Deputy Editor
Jennifer S Tirnauer, MD


Options for anticoagulation have been expanding steadily over the past few decades, providing a greater number of agents for prevention and management of thromboembolic disease. In addition to heparins and vitamin K antagonists, anticoagulants that directly target the enzymatic activity of thrombin and factor Xa have been developed. Appropriate use of these agents requires knowledge of their individual characteristics, risks, and benefits.

This topic review discusses practical aspects of the use of direct thrombin inhibitors (oral and parenteral) and oral direct factor Xa inhibitors, along with a brief mention of other anticoagulants in development. Indications and efficacy of these agents in specific clinical settings are presented in separate topic reviews on the relevant conditions. (See 'Indications' below.)

Management of bleeding and perioperative management of patients receiving direct thrombin inhibitors or direct factor Xa inhibitors is also discussed in detail separately. (See "Management of bleeding in patients receiving direct oral anticoagulants" and "Perioperative management of patients receiving anticoagulants".)

The following topic reviews discuss other anticoagulants in clinical use:

Heparins – (See "Heparin and LMW heparin: Dosing and adverse effects".)

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Literature review current through: Nov 2017. | This topic last updated: Nov 01, 2017.
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