Pharmacology of Oral Anticoagulants

Patients with atrial fibrillation are known to be at significant risk of stroke. Preventative therapy with an anticoagulant is typically indicated based on patient risk factors. Anticoagulant therapy for decades has consisted of only vitamin K antagonists, such as warfarin, but additional options are now available. These include the direct thrombin inhibitor dabigatran and the direct factor Xa inhibitors rivaroxaban, apixaban, and edoxaban. Warfarin has complex pharmacology, pharmacokinetics, and pharmacodynamics. There are also a number of drug interactions and food interactions that must be considered with the use of warfarin. Direct oral anticoagulants provide a different pharmacology to providing their anticoagulant effect. The agents currently available have differences in pharmacology, pharmacokinetics, and drug interaction potential. Regardless of the anticoagulant selected for the patient, clinicians must have a firm foundation in the pharmacology, pharmacokinetics, dosing, and knowledge of drug interactions to provide optimal care to their patients.