Direct oral anticoagulants: the available agents and practical considerations

Abstract

Thrombosis remains one of the leading causes of death in the world, and South Africa is no exception. In addition, as the population across the globe is ageing, the burden of stroke due to cardiovascular disease and atrial fibrillation (AF) is proliferating exponentially. Infection with HIV, which is prevalent in Africa, contributes significantly to the risk of both venous and arterial thrombosis. Anticoagulation can prevent thrombotic events but careful consideration of the choice of drug is needed to ensure efficacy and safety in the multifaceted anticoagulation drug arena. Although warfarin is still widely used, the direct oral anticoagulants (DOACs) are becoming the agents of choice for acute and chronic anticoagulation. The DOACs are a group of individual drugs, and choice of agent, and even dose, will depend on therapeutic indication, renal and liver function, age, body weight, comorbidities, previous medical history and concomitant medication. In this article the key pharmacological characteristics, indications and contraindications of the available DOACs in South Africa are summarised with the aim to assist with choosing the right anticoagulant, for the right patient, at the right dose, for the right duration.