Direct anticoagulants for atrial fibrillation. Update 2014

For several decades vitamin K antagonists (VKA) were the standard for stroke prevention in atrial fibrillation. Because of inconvenience associated with their use (frequently VKA levels cannot be consistently maintained within the therapeutic range, e.g. due to food and drug interactions, which necessitates regular control of international normalized ratios) alternative compounds have recently been developed, the direct oral anticoagulants (DOACs) dabigatran (a direct antithrombin) as well as rivaroxaban, apixaban and edoxaban (direct factor Xa inhibitors). All these agents show a predictable pharmacokinetic profile making routine laboratory controls unnecessary. Moreover, DOACs do not only show a similar or even better efficacy, but also a more attractive safety profile in terms of similar or less major bleeding complications, where all DOACs significantly reduce the rate of intracranial bleeding when compared to VKAs. This review summarizes the pharmacological characteristics and clinical study results of DOACs that have been tested in phase 3 trials.