The new era of anticoagulation.

Warfarin has been approved by the U.S. Food and Drug Administration for medical use as an anticoagulant for more than 60 years. Although it has been an effective anticoagulant, its use is accompanied by several pitfalls, which has led to research and the discovery of new additional groups of anticoagulants: direct thrombin inhibitors, such as dabigatran, and direct factor Xa inhibitors, such as rivaroxaban and apixaban. These new anticoagulants are fast-acting, noninferior to warfarin in preventing stroke in patients with nonvalvular atrial fibrillation, and do not require monitoring. More data are accumulating to support their use in the prevention and management of venous thromboembolism. This article reviews the literature on these novel anticoagulants, including their pharmacokinetics and treatment indications.