Direct Oral Anticoagulants: An Updated Systematic Review of Their Clinical Pharmacology and Clinical Effectiveness and Safety in Patients With Nonvalvular Atrial Fibrillation

Direct oral anticoagulants have been an increasingly used class of drugs in the setting of nonvalvular atrial fibrillation, defying vitamin K antagonists' monopoly when it comes to anticoagulation, due to its several limitations. Direct oral anticoagulants have entered the market as a non-inferior and safer option in comparison with vitamin K antagonists, as their respective phase III clinical trials proved. The aim of this article was to update and summarize data on their clinical pharmacology and to review real-world data to know their comparative effectiveness and safety. We performed a systematic review using PubMed, Google Scholar, Embase and Web Of Science as search engines. Regarding pharmacodynamics, there were no substantial changes reported from their original profile. There were many advances in the knowledge about clinical pharmacokinetics of direct oral anticoagulants which has had a direct impact on their clinical use, mainly related to drug-drug interactions. In real-world setting, Direct Oral Anticoagulants have shown to be non-inferior in preventing thromboembolic events compared to Vitamin K antagonists. In regards to safety, DOACS have shown a lower bleeding risk relative to Warfarin. Comparison between DOACS has demonstrated Rivaroxaban to have the highest bleeding risk. Overall, the evidence gathered showed little changes from the original data presented in phase III clinical trials, concluding that their real-world use coincides in great manner with them. This article is protected by copyright. All rights reserved.