In the United States today, anticoagulant therapy is prescribed for individuals who are at risk for deep vein thrombosis, pulmonary embolism and stroke due to atrial fibrillation.  Historically, and even today, most patients with a blood clotting disorder are treated with warfarin and heparin.  These medications require careful monitoring, and have several limitations, like narrow therapeutic  parameters, variability of results between patients, a slow onset of action, and many, many drug and food interactions. The new Direct-Acting Oral Anticoagulants (DOACs) do not require monitoring, and they are prescribed based on the condition treated as fixed dose medication.  Their dosage is based upon the patient’s kidney function, age, weight, and other medications the patient is currently prescribed.  The DOACs also do have limitations and challenges to their use.

In this class, we will briefly discuss the clotting mechanism, and then we will review the administration, mechanism of action, and potential adverse reactions to warfarin, and five DOACs on the market today.  We will also discuss the reversal agents available for these drugs and appropriate patient education.